PAID CLAIMS DETAIL                                                  
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230801581733                                           PAGE:               1 of 60           
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/28/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         4 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      08/01/2023        

            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   254957929470753401   07/18/2023          (6)    ($37.90)       $0.00
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   479181324247863401   07/28/2023          30      $401.38      $16.15
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   553410831407863401   07/28/2023          30       $84.50      $11.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   521726704163163401   07/28/2023          90      $377.50       $0.00
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   702127766258553401   07/27/2023          90      $976.04      $20.11
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   249127059458553401   07/27/2023          90       $55.84       $2.17
    014267-01                103106368001 183468098  RABATIN          DEBORA     18   329306329036963401   07/28/2023          84      $525.33     $375.80
    014267-01                113990909001 199624011  LASSAK           LYNN       18   331846554797513401   07/25/2023          90      $447.13       $0.00
    014267-01                113990909001 199624011  LASSAK           LYNN       18   907172100778763401   07/28/2023          90      $498.15      $13.15
    014267-01                113990909001 199624011  LASSAK           LYNN       18   823774534997513401   07/25/2023          90      $447.93       $8.18
    014267-01                105143186001 207564217  BAUM             SUSAN      18   25632841674333401    07/26/2023          25       $86.31       $1.97
    014267-01                105143186001 207564217  BAUM             SUSAN      18   266847617264583401   07/29/2023          90      $806.03      $14.33
    014267-01                105143186001 207564217  BAUM             SUSAN      18   417994233739323401   07/25/2023           7       $50.49       $5.84
  014267-01 Total                                                                                                                    $4,718.73     $468.70
  014267-03
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   562299085540963401   07/28/2023          50      $257.00      $65.77
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   355305231786733401   07/26/2023          25       $74.50       $6.97
    014267-03                100658703001 125504688  MULLIGAN         IVAN       01   244269505168482401   07/23/2023          30       $38.98       $9.76
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   539433683776472401   07/23/2023          25      $341.99      $58.04
    014267-03                101220663001 159625419  ECKENRODE        PAUL       18   958760681782892401   07/24/2023          28      $768.36     $513.90
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   567077693715323401   07/25/2023          90    $1,045.81      $78.65
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   41932301418223401    07/25/2023          30       $39.61       $0.00
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   714220881208613401   07/25/2023          90      $828.78      $23.32
    014267-03                101369778001 161607101  LACUE            ERIN       18   543635191616863401   07/28/2023          30       $74.81      $24.10
    014267-03                101369778001 161607101  LACUE            ERIN       18   536811634516863401   07/28/2023          30    $1,072.51     $691.31

                                                                                                                                               PAGE:2 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                101383854001 161744937  LANE             JULIE      18   6792890899863401     07/28/2023          90      $285.16       $3.67
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   91720721381863401    07/28/2023          30       $84.07       $5.42
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   825734323912863401   07/28/2023          50      $437.00      $65.52
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   296476849912863401   07/28/2023          50      $786.16      $39.10
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   749994653381863401   07/28/2023          30       $23.51       $7.15
    014267-03                101760095001 166629321  BLAKE            JODY       01   703106764383733401   07/26/2023          28    $1,130.42     $881.89
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   189542530197583401   07/29/2023          30      $271.09       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   410137756996043401   07/13/2023          (4)    ($10.63)       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   944318394858253401   06/04/2023          30      $807.99     $529.96
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   677802400018583401   07/29/2023          30       $65.00      $28.90
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   759857887832353401   07/27/2023          30      $807.99     $529.96
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   478401754497583401   07/29/2023           4       $10.63       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   402956824687583401   07/29/2023          30      $369.12      $16.80
    014267-03                101995873001 169646253  MANACK           BRANDON    01   420056649194073401   07/28/2023          21       $21.42       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   182207123772653401   07/27/2023          30      $226.26      $12.04
    014267-03                102486556001 175629643  HRITZ            DARREN     01   228707886897763401   07/28/2023          30      $207.32      $39.36
    014267-03                102486556001 175629643  HRITZ            SANDRA     18   125716790687513401   07/25/2023          10       $44.95       $0.00
    014267-03                102486556001 175629643  HRITZ            DARREN     01   456496389756053401   07/27/2023         100        $1.90       $1.45
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   753182504870713401   07/25/2023          90      $606.18      $43.31
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   781334403870713401   07/25/2023          90       $74.86      $20.79
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   760799885726533401   07/26/2023          84      $195.40      $28.64
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   37106834240182401    07/23/2023          30      $879.99     $639.88
    014267-03                102972300001 181604543  SCHIRATO         ISABELLA   19   96137669379533401    07/26/2023          30      $432.99     $311.76
    014267-03                102972300001 181604543  SCHIRATO         ISABELLA   19   384702444379533401   07/25/2023         (30)   ($964.70)   ($503.82)
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   208267359082313401   07/25/2023          30      $145.33       $0.00
    014267-03                102972300001 181604543  SCHIRATO         ISABELLA   19   599827307204123401   07/25/2023          30      $964.70     $503.82
    014267-03                103039127001 182562529  BEACH            WESLEY     01   404534103595892401   07/24/2023          30      $307.73      $42.31
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   397805581027743401   07/27/2023          50      $145.33       $5.51
    014267-03                103379409001 186624451  LOBICK           BRIAN      18   28906919169053401    07/27/2023          15       $11.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   741735221044513401   07/25/2023          20    $1,475.65       $9.06
    014267-03                128323370001 189744510  TOTH             BRIANNA    18   38037247638513401    07/25/2023          30      $105.35      $21.12
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   370667726814992401   07/24/2023          90      $519.63      $30.77

                                                                                                                                               PAGE:3 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   362747543291992401   07/24/2023          25       $87.10      $50.65
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   29634843981992401    07/24/2023           6      $398.78       $0.00
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   528177767191992401   07/24/2023          90      $440.69      $74.49
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   932399885573253401   07/27/2023          90      $855.62     $150.69
    014267-03                103818021001 191709419  OWENS            ALLISON    18   739237907499023401   07/25/2023          30      $135.44       $0.00
    014267-03                103818021001 191709419  MULRANEY         AVA        19   112060291850273401   07/28/2023          30      $398.86      $11.54
    014267-03                103985610001 193685616  SZYMUSIAK        MATTHEW    01   94157906068480401    07/12/2023          90    $2,174.81   $1,570.72
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   626486520213303401   07/24/2023          90       $75.19      $16.87
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   355236229823913401   07/24/2023         (30) ($1,153.35)    ($48.20)
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   696937856823913401   07/25/2023          30    $1,153.35      $48.20
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   498247207168492401   07/24/2023          30    $1,153.35      $48.20
    014267-03                104072125001 194663982  FARABAUGH        PARKER     19   845847287080633401   07/26/2023          90      $104.94      $12.34
    014267-03                104072125001 194663982  FARABAUGH        PARKER     19   954619525880633401   07/26/2023          90      $145.20      $50.37
    014267-03                104217524001 196520554  FORD             LAURA      18   887677956930193401   07/29/2023          30      $663.99     $476.85
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   476897667874992401   07/24/2023           1       $56.12       $0.00
    014267-03                104400727001 198662868  FOX              LISA       18   160034534574033401   07/26/2023          90       $40.64       $1.84
    014267-03                120189904001 199707914  KEENER           COREY      01   66642924213103401    07/24/2023          25      $341.99      $58.04
    014267-03                120189904001 199707914  KEENER           COREY      01   644202621708003401   07/18/2023         (60)   ($110.99)    ($10.94)
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   415767857092353401   07/27/2023          30      $465.54     $108.88
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   628904323092353401   07/26/2023         (30)   ($465.54)   ($108.88)
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   52264063989633401    07/26/2023          30      $465.54     $108.88
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   317506080446833401   07/26/2023           7      $162.89       $0.00
    014267-03                105154214001 207627750  KLINE            BRIAN      01   394544284849513401   07/25/2023           7       $51.18       $0.00
    014267-03                105481344001 211520772  STRASSER         MICHAEL    18   900139395938763401   07/28/2023          90      $633.55      $30.77
    014267-03                105481344001 211520772  STRASSER         JANINE     01   630862311018813401   07/25/2023          90      $317.91       $6.03
    014267-03                105494211001 211588239  PATRICK          VICKI      18   759636684546173401   06/06/2023          (2)   ($249.05)   ($160.62)
    014267-03                105494211001 211588239  PATRICK          VICKI      18   805794003053313401   07/25/2023          30    $3,019.18   $1,765.76
    014267-03                114739500001 211701060  FEES             JORDAN     18   319606059964003401   07/24/2023          30       $12.60       $0.00
    014267-03                114739500001 211701060  FEES             JORDAN     18   97702771764003401    07/24/2023          30      $158.01       $0.00
    014267-03                114739500001 211701060  FEES             JORDAN     18   905766599382863401   07/28/2023          30       $71.50       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   604284363253401      07/27/2023          30      $988.92     $774.36
    014267-03                114739500001 211701060  FEES             AMBER      01   164096000074003401   07/24/2023          30      $124.55       $0.00

                                                                                                                                               PAGE:4 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                114739500001 211701060  FEES             JORDAN     18   725844444274003401   07/24/2023          30      $449.08     $234.51
  014267-03 Total                                                                                                                   $28,179.24  $10,057.54
  014267-05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   422756600970833401   07/26/2023          50      $758.14      $26.94
    014267-05                101665655001 165520467  FISANICK         BASIL      01   609946040517743401   07/27/2023          13       $90.49       $0.00
    014267-05                101665655001 165520467  FISANICK         BASIL      01   882581894293283401   07/29/2023          12      $133.00      $11.05
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   96494183887633401    07/26/2023           5       $12.54       $0.00
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   998907806289633401   07/17/2023         (45)   ($147.78)    ($12.62)
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   177954854735053401   07/27/2023          30      $796.85       $9.95
    014267-05                117497733001 169665790  DATSKO           STACY      18   373432714934253401   07/27/2023           7       $50.38       $0.27
    014267-05                133049535001 169741183  NORMAN           MICHAEL    01   234296344300673401   07/28/2023          10      $108.53       $6.29
    014267-05                112950694001 171683760  GONZALEZ         CARLOS     01   132507259676103401   07/24/2023          30      $164.75       $4.09
    014267-05                112950694001 171683760  GONZALEZ         CARLOS     01   621168764886103401   07/24/2023          30       $51.99       $0.00
    014267-05                112950694001 171683760  GONZALEZ         CARLOS     01   438852994774203401   07/24/2023          30        $3.99       $1.09
    014267-05                112950694001 171683760  GONZALEZ         CARLOS     01   760402961676103401   07/24/2023          30       $29.81       $0.00
    014267-05                112950694001 171683760  GONZALEZ         CARLOS     01   458477976152683401   07/29/2023          90    $1,485.51     $441.21
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   693502301629283401   07/29/2023          30      $398.20       $0.00
    014267-05                115391991001 174547012  JACOBS           TIMOTHY    18   770947646872313401   07/25/2023          25      $341.99      $58.04
    014267-05                102567951001 176622574  LOMBARDO         TINA       18   180895771039182401   07/23/2023          30      $146.34       $0.00
    014267-05                102653549001 177643765  KUDLAWIEC        ANGELA     01   26180771364373401    07/15/2023         (90)    ($60.28)    ($20.92)
    014267-05                102653549001 177643765  KUDLAWIEC        KAITLYN    19   99326099777863401    07/28/2023          15      $242.56      $62.95
    014267-05                102864840001 180482050  PARONISH         AMY        01   375052611757303401   07/24/2023          42       $75.52      $20.90
    014267-05                102864840001 180482050  PARONISH         AMY        01   952601618614583401   07/29/2023          90    $1,970.92   $1,502.51
    014267-05                102864840001 180482050  PARONISH         AMY        01   571017176572983401   07/29/2023          90    $1,016.59     $286.48
    014267-05                103380060001 186626373  SCALESE          QUINN      19   164621554520553401   07/27/2023          10       $15.01       $0.00
    014267-05                103380060001 186626373  SCALESE          QUINN      19   851736279420553401   07/27/2023           7       $11.50       $0.00
    014267-05                104144215001 195582778  DUMM             JENNIFER   18   6846560423103401     07/24/2023           7       $20.69       $0.00
    014267-05                104213378001 196487222  MICCO            GARY       01   335706564185453401   07/27/2023          50       $67.10       $5.58
    014267-05                104213378001 196487222  MICCO            GARY       01   529434713285713401   07/25/2023          30      $176.42      $68.73
    014267-05                104241138001 196668859  MCCRACKEN        BRENNA     19   882926740710333401   07/26/2023          30      $119.24      $10.45
    014267-05                110289777001 198665728  SLAVIK           ROBERT     01   802281128220583401   07/29/2023          50      $206.49      $64.39
    014267-05                110289777001 198665728  SLAVIK           ROBERT     01   196572314825783401   07/29/2023          12       $13.83       $0.00

                                                                                                                                               PAGE:5 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   830878774668763401   07/28/2023          30      $271.72       $4.06
    014267-05                104564922001 200649293  BRADLEY          RACHEL     19   970577477800073401   07/28/2023          28      $146.68      $13.70
    014267-05                104639290001 201607083  BONATESTA        MELISSA    18   129122051075093401   07/29/2023          30      $184.48       $5.64
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   928607716988153401   07/27/2023          30      $560.62     $429.85
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   746501248565093401   07/29/2023          58      $181.21     $125.37
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   958147196697223401   07/11/2023         (58)   ($181.21)   ($125.37)
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   133571664814583401   07/29/2023          30      $159.01       $0.00
    014267-05                117760647001 208602985  ABEL             TONI       18   47166789013733401    07/26/2023          14       $45.68      $20.74
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   357906220746403401   07/24/2023          30       $64.52      $16.98
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   378529395346403401   07/24/2023          30      $147.16      $11.92
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   400586864056403401   07/24/2023          11       $77.36      $42.04
    014267-05                117760647001 208602985  ABEL             SARAH      19   44418004247863401    07/28/2023          30       $99.89       $9.60
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   266982444771563401   07/28/2023          16    $2,015.00       $8.07
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   534351428975173401   07/15/2023         (12)    ($59.99)    ($15.10)
    014267-05                105312745001 209560853  KUDLAWIEC        MELISSA    18   366245141120692401   07/24/2023          30       $51.99       $0.57
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   93142310065053401    07/27/2023          90      $163.19     $106.04
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   160700521642053401   07/27/2023          90      $813.16      $30.68
  014267-05 Total                                                                                                                   $13,040.79   $3,232.17
  014267-06
    014267-06                101267523001 160429168  PETRISKO         MICHAEL    01   649344913495483401   07/29/2023          90      $474.04      $13.18
    014267-06                112636195001 161586341  PARRISH          CHRISTIN   18   675424853390023401   07/25/2023          13      $107.99      $52.52
    014267-06                114965976001 167642610  DOLANSKY         SHEILA     18   536174023387553401   07/27/2023          33       $46.79       $2.90
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   468386089289182401   07/23/2023          30       $30.70       $0.00
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   283565051353613401   07/25/2023          45       $65.43       $8.85
    014267-06                103371598001 186582068  SEDLOCK          JOHN       01   524895201127743401   07/27/2023          30       $85.45       $0.00
    014267-06                119289043001 201600245  NEUMANN          MARIE      19   481124434316413401   07/25/2023          84       $24.00      $24.00
  014267-06 Total                                                                                                                      $834.40     $101.45
  014267-07
    014267-07                121106664001 159703665  KANE             ALANNAH    19   120135101579203401   07/24/2023           2       $18.99       $0.00
    014267-07                101529427001 163623940  WATT             LYNN       01   127926720422863401   07/23/2023         (50)    ($25.00)    ($10.00)
    014267-07                101529427001 163623940  WATT             LYNN       01   700511364422863401   07/28/2023          50       $25.00      $10.00
    014267-07                101529427001 163623940  WATT             MORGAN     19   295736124034553401   07/27/2023          30      $141.44       $0.00

                                                                                                                                               PAGE:6 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                101529427001 163623940  WATT             LYNN       01   638207686890382401   07/23/2023          50       $25.00      $10.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   64656889842433401    07/26/2023          30      $852.84     $585.64
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   463966549095103401   07/10/2023         (30)    ($41.68)       $0.00
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   720527309070973401   07/29/2023          90      $380.29      $17.30
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   16882910316653401    07/27/2023          50       $84.89      $22.77
    014267-07                102080665001 170683038  MICHINA          LUKE       19   803877989869963401   07/28/2023          30       $28.95       $0.00
    014267-07                102080665001 170683038  MICHINA          BRIDGET    18   978767926869963401   07/28/2023          90    $1,041.18      $70.46
    014267-07                102160098001 171649555  BAKER            KIMBERLY   18   245737457727582401   07/23/2023          90      $246.97       $7.41
    014267-07                102160098001 171649555  BAKER            MARK       01   353408084474333401   07/26/2023          30      $269.34       $0.00
    014267-07                102967311001 181580382  BLACK            BRAD       01   194148144341153401   07/27/2023          30      $142.92       $0.00
    014267-07                102967311001 181580382  BLACK            BRAD       01   752857173693253401   07/27/2023          30      $176.50       $0.00
    014267-07                102967311001 181580382  BLACK            BRAD       01   614762751441153401   07/27/2023          90      $447.13      $14.93
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   399796079173583401   07/29/2023          91      $271.30      $36.70
    014267-07                122806756001 181726437  MARRA            BRYAN      18   70237087137582401    07/23/2023          14       $31.25       $8.67
    014267-07                103024367001 182466226  WARNER           DAVID      01   993364453968792401   07/24/2023          30       $11.25       $0.00
    014267-07                103024367001 182466226  WARNER           DAVID      01   516747789078792401   07/24/2023          30       $64.30       $0.00
    014267-07                110593405001 185480154  AUDLEY           LINDA      18   775986910670633401   07/26/2023          28       $13.04       $0.00
    014267-07                110593405001 185480154  AUDLEY           LINDA      18   648558084070633401   07/26/2023           7      $105.07       $0.00
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   588492804779992401   07/24/2023          50       $42.22       $7.10
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   528656730504333401   07/26/2023          50       $11.11       $0.00
    014267-07                103723690001 190641355  GLASS            SHARON     18   584517987493123401   07/25/2023          30      $146.30       $0.00
    014267-07                103879349001 192529999  WATT             LISA       01   755291144686053401   07/27/2023         100      $578.36      $21.23
    014267-07                103879349001 192529999  WATT             LISA       01   373221318173583401   07/29/2023          90       $50.33      $10.99
    014267-07                103879349001 192529999  WATT             KEVIN      18   766854653218813401   07/25/2023           2      $191.97     $154.00
    014267-07                135720029001 196765983  MYERS            MARISSA    18   598824213914333401   07/26/2023          30      $124.35       $9.49
    014267-07                104804112001 203580135  SMITH            MICHELE    18   203097436521933401   07/26/2023          30    $1,160.01     $901.12
    014267-07                105150385001 207605575  KUNTZ            THERESA    18   540862010182863401   07/28/2023          90      $279.00      $22.87
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   31396289610333401    07/26/2023          30       $68.41       $0.43
  014267-07 Total                                                                                                                    $6,963.03   $1,901.11
  014267-08
    014267-08                114847328001 071624700  RENNINGER        JAMES      01   936016269118073401   07/28/2023          30       $79.42       $0.00
    014267-08                101267755001 160429635  FLORA            CLARISSA   01   232742631940992401   07/24/2023          30      $378.32      $71.50

                                                                                                                                               PAGE:7 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                101267755001 160429635  FLORA            CLARISSA   01   812846999414583401   07/29/2023          90      $276.60      $27.87
    014267-08                127928506001 162602138  TREON            TINA       18   348422584509963401   07/28/2023          28    $1,357.49     $881.89
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   199694901987073401   07/28/2023          30      $159.39       $0.00
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   354132034847613401   07/25/2023          84       $86.54      $47.60
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   240487253287613401   07/25/2023          84       $64.92      $30.90
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   692012831623073401   07/28/2023          50      $619.73      $16.59
    014267-08                116871611001 173605841  MURPHY           DAVID      01   842812274491353401   07/27/2023          25       $92.79      $25.31
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   981925020872722401   07/20/2023          84   $25,377.63  $20,276.73
    014267-08                102576284001 176682098  YARNISH          MISTY      18   625584353789783401   07/29/2023          90      $362.84      $26.33
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   935745611499892401   07/24/2023          90      $578.84      $13.18
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   582886270015333401   07/26/2023          90      $116.31       $3.88
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   367297827905333401   07/26/2023          90      $447.13      $14.93
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   776674723605333401   07/26/2023          28    $1,357.49     $881.89
    014267-08                103043271001 182585206  FINET            THERESA    18   206556619110992401   07/24/2023          30      $763.99     $552.10
    014267-08                103043271001 182585206  FINET            THERESA    18   479727773382173401   07/28/2023          90    $1,197.33      $46.96
    014267-08                103043271001 182585206  FINET            THERESA    18   615344844042563401   07/28/2023          90      $256.35       $6.03
    014267-08                103537183001 188580574  HEBERT           LINDA      18   788134524988203401   07/18/2023         (90)    ($98.99)    ($30.00)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   987547576298203401   07/24/2023          90       $98.99      $30.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   252909795107733401   07/26/2023          90    $1,713.99   $1,223.58
    014267-08                103537183001 188580574  BERTRAM          GRACE      19   942212200951093401   07/16/2023         (91)   ($268.55)    ($24.01)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   348722210375453401   07/27/2023          90      $508.50      $12.34
    014267-08                103711350001 190563467  PASSONETTI       DAVID      01   545557737706403401   07/24/2023          90      $688.09     $115.53
    014267-08                121090722001 192600296  PACKARD          STACIE     18   751056060387813401   07/25/2023          30      $178.53       $0.00
    014267-08                121090722001 192600296  PACKARD          SHAYLEE    19   309157989456913401   07/25/2023          30       $79.45      $18.07
    014267-08                114929432001 197469266  HITE             DEBRA      18   905517799175533401   07/26/2023          90      $366.40      $58.04
    014267-08                104393562001 198605554  MCBREEN          TRICIA     01   21288924944273401    07/28/2023          90      $976.04      $48.73
    014267-08                105133504001 207506202  LITZINGER        SUSAN      01   937644944355533401   07/26/2023          90       $10.00       $0.00
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   555982191227433401   07/26/2023          30       $36.21       $0.00
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   914966494227433401   07/26/2023          30      $672.90     $520.75
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   242640691227433401   07/26/2023          30       $22.85      $11.86
  014267-08 Total                                                                                                                   $38,557.52  $24,908.58
  014267-12

                                                                                                                                               PAGE:8 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   596948804222233401   07/26/2023          30      $271.86      $43.11
    014267-12                101592912001 164561540  KIVISTO          MARY       18   636486649305533401   07/26/2023          34       $59.84      $26.77
    014267-12                101592912001 164561540  KIVISTO          MARY       18   361576504687943401   07/27/2023          30       $45.50       $8.48
    014267-12                103116452001 183526057  DAMIN            MARY       18   197662940830453401   07/27/2023           2      $107.43      $50.42
    014267-12                103337724001 186380155  LASOTA           DAVID      01   31184563224513401    07/25/2023          10       $73.13      $14.34
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   562679065264803401   07/24/2023          90       $49.90       $4.39
    014267-12                103337724001 186380155  LASOTA           DAVID      01   230066164084803401   07/24/2023          90      $187.60      $36.54
  014267-12 Total                                                                                                                      $795.26     $184.05
  014267-13
    014267-13                102118780001 171382795  ORR              GEMAINE    18   928771458731453401   07/27/2023          28       $81.97      $48.88
    014267-13                103271646001 185480430  GOODERHAM-KRUG   BARBARA    18   359168644182103401   07/24/2023          30       $77.51      $11.43
    014267-13                103527331001 188520159  MONTANARO        RITA       18   843564111538943401   07/13/2023         (90)   ($394.94)     ($9.76)
    014267-13                103527331001 188520159  BARONI           RITA       18   436234133033863401   07/28/2023          90      $394.94       $9.76
    014267-13                104707411001 202484824  POMPA            LOUISE     18   250107039822713401   07/25/2023          90      $805.05      $19.33
  014267-13 Total                                                                                                                      $964.53      $79.64
  014267-15
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   41074574644992401    07/24/2023          30      $140.45       $0.00
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   636936710982303401   07/24/2023          30      $484.99     $234.51
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   771424891488573401   07/12/2023         (28) ($1,228.64)   ($965.94)
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   757778264729503401   07/22/2023         (28) ($1,123.92)   ($881.89)
    014267-15                102057315001 170525384  LEAHEY           BRADY      18   46844693297513401    07/25/2023          90      $367.03       $4.93
    014267-15                102304935001 173545673  PARONISH         REBECCA    01   497694703283333401   07/25/2023         (99)   ($337.99)   ($200.62)
    014267-15                102304935001 173545673  PARONISH         REBECCA    01   733714174142913401   07/25/2023          99      $337.99     $200.62
    014267-15                102874578001 180540093  LINK             EDWARD     18   433740111192313401   07/25/2023          30       $51.99       $0.00
    014267-15                102874578001 180540093  LINK             EDWARD     18   78394143192313401    07/25/2023          30      $208.83       $3.91
    014267-15                103212512001 184605964  KIMMEL           RICHARD    18   304435951788453401   07/27/2023          30      $229.40      $33.67
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   367932811156913401   07/07/2023         (30)   ($524.33)   ($401.52)
    014267-15                104714087001 202525913  JUBAS            GARY       01   557516540842833401   07/26/2023           6       $37.39       $2.54
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   805121588877763401   07/28/2023           5       $49.44       $0.00
    014267-15                104714087001 202525913  JUBAS            GARY       01   529186490542833401   07/26/2023           5       $49.44       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   360801524107863401   07/28/2023           6       $37.39       $2.54
  014267-15 Total                                                                                                                  ($1,220.54) ($1,967.25)

                                                                                                                                               PAGE:9 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-22
    014267-22                102060071001 170543832  WIRICK           EVA        18   984666960199053401   07/27/2023          34       $42.73      $16.17
  014267-22 Total                                                                                                                       $42.73      $16.17
  014267-34
    014267-34                103601825001 189449008  MARKOVICH        FRANCIS    18   354017807834003401   07/21/2023          45    $1,216.35       $0.00
  014267-34 Total                                                                                                                    $1,216.35       $0.00
  014267-36
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   662637536949963401   07/28/2023          30       $78.05       $6.54
    014267-36                109914485001 163626883  SHROYER          ROY        01   38330271786733401    07/26/2023          30      $124.55       $0.00
    014267-36                109914485001 163626883  SHROYER          WENDY      18   885312711872313401   07/25/2023          28       $32.78       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   698859895370713401   07/25/2023          30      $268.35      $10.08
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   253191224258373401   07/28/2023          30      $287.30     $211.31
    014267-36                132201566001 182642148  REVESZ           STACEY     19   338185591490203401   07/24/2023          34       $17.00       $1.10
    014267-36                103457061001 187582626  BAILEY           CYNTHIA    01   700296179342053401   07/27/2023          30      $159.01       $0.00
    014267-36                103457061001 187582626  BAILEY           CYNTHIA    01   176342411442053401   07/27/2023          30      $362.44     $109.92
    014267-36                103555014001 188707325  BATEMAN          NICOLE     01   744354331478583401   07/29/2023          30      $155.29       $0.00
    014267-36                104564544001 200647718  DIEHL            OLIVIA     01   66781958838763401    07/28/2023          30    $1,146.87     $458.80
    014267-36                104564544001 200647718  DIEHL            DARRELL    18   25504044958943401    07/27/2023          30      $423.98      $63.16
    014267-36                104564544001 200647718  DIEHL            OLIVIA     01   741568564374333401   07/26/2023          30    $1,670.31   $1,284.50
    014267-36                118690744001 203684634  BEHORY           JESSICA    01   623797189453583401   07/29/2023          28       $14.18      $14.18
    014267-36                112912518001 209687274  MAZZARELLA       MATTHEW    18   931536229229333401   07/26/2023          30        $9.00       $0.00
    014267-36                112912518001 209687274  MAZZARELLA       MATTHEW    18   761836910229333401   07/26/2023          30        $4.00       $0.00
  014267-36 Total                                                                                                                    $4,753.11   $2,159.59
  014267-37
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   203256000479933401   07/26/2023          25       $86.15       $0.00
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   950908704946053401   07/27/2023          90      $184.88       $0.00
    014267-37                134922147001 178526604  DILLON           LISA       18   282861588295173401   07/28/2023          14       $82.77       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   371785561763073401   07/28/2023          30      $138.75       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   727307616798182401   07/23/2023          28       $10.84       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   428456624343073401   07/28/2023          30      $872.99     $624.82
    014267-37                103459963001 187600390  BRYAN            KAREN      18   204079375453613401   07/25/2023          30       $19.81       $0.00
    014267-37                104963730001 205523165  WHITED           CATHERIN   18   470666724826082401   07/23/2023          30      $221.86       $0.00

                                                                                                                                              PAGE:10 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-37                104963730001 205523165  WHITED           CATHERIN   18   581360571580713401   07/25/2023          30       $99.99       $0.76
    014267-37                104963730001 205523165  WHITED           CATHERIN   18   853141058133863401   07/28/2023          30      $498.72       $3.28
    014267-37                104963730001 205523165  WHITED           CATHERIN   18   54869635742863401    07/28/2023           1       $14.30       $0.00
    014267-37                104963730001 205523165  WHITED           CATHERIN   18   996944923826082401   07/23/2023          30       $50.96       $0.00
  014267-37 Total                                                                                                                    $2,282.02     $628.86
  014267- Total                                                                                                                    $101,127.17  $41,770.61
Drug Total                                                                                                                         $101,127.17  $41,770.61
                                                                                                                                                            
HDHP PPO
  014267-54
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713845140          07/20/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22714200639          07/25/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713845140          07/20/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713845140          07/20/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         WILLIAM    18   307795291129713401   07/25/2023          90       $60.70      $16.90
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22714200639          07/25/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22714200639          07/25/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         WILLIAM    18   797737257919713401   07/25/2023          90      $226.30      $25.58
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22214001155          07/17/2023           1      $151.00      $51.75
    014267-54                120265426001 160589945  WORTHINGTON      SANDRA     18   363696870324513401   07/25/2023          30      $222.86       $8.72
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   22214124496          07/24/2023           1      $142.00       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       REBECCA    01   22214184150          06/30/2023           1      $200.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22814225186          07/04/2023           1       $15.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22814225189          07/04/2023           1       $60.00       $0.00
    014267-54                101363408001 161569102  COOK             MARIE      01   22814040427          06/30/2023           1      $150.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22814252896          07/25/2023           1      $142.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22814225186          07/04/2023           1      $200.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22814225189          07/04/2023           4       $40.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   777617169522892401   07/24/2023          30      $217.61       $8.54
    014267-54                101514808001 163542690  FULLER           KEVIN      01   163222051422892401   07/24/2023          30       $47.91       $6.39
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   865390391434513401   07/25/2023          15       $72.89      $18.75
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   964198538035981401   07/18/2023          28    $4,305.50   $3,683.36

                                                                                                                                              PAGE:11 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101514808001 163542690  FULLER           KEVIN      01   444844164622892401   07/24/2023          30      $108.38       $7.97
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514027407          07/24/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513933639          07/21/2023           1      $150.00      $73.36
    014267-54                101679413001 165601158  SIMMONS          ABIGAIL    19   138716154640182401   07/23/2023          28       $37.50      $14.86
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22514221075          07/18/2023           2      $266.00     $157.29
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   445051934382053401   07/27/2023           1      $199.72     $156.15
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514027407          07/24/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514027407          07/24/2023           1       $33.00      $16.68
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514072717          07/25/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514072717          07/25/2023           1       $33.00      $16.68
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   512876344617353401   07/27/2023          10       $34.42       $5.20
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22514072717          07/25/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22514202759          07/03/2023           1      $150.00      $85.70
    014267-54                101682663001 165620949  GIBSON           GABRIELL   19   363677496192353401   07/27/2023           5       $68.97       $0.00
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   288876040222233401   07/26/2023          30        $7.84       $2.54
    014267-54                131732377001 167623544  MARSH            SHELLY     18   958636944324333401   07/26/2023          30       $47.27      $12.90
    014267-54                131732377001 167623544  MARSH            SHELLY     18   704924243064903401   07/25/2023          90      $261.40      $15.28
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613912541          07/14/2023           1      $482.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613912541          07/14/2023           1      $237.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613912541          07/14/2023           1      $237.00       $0.00
    014267-54                101979530001 169545952  KOKOSKI          KENNEDY    19   267814824265053401   07/27/2023          28       $64.45      $12.49
    014267-54                102080764001 170683398  STRAZISAR        ELSA       19   22114087919          07/25/2023           1       $35.00      $16.70
    014267-54                102080764001 170683398  STRAZISAR        ROBERT     01   22114082669          07/11/2023           1      $114.23      $74.97
    014267-54                102080764001 170683398  STRAZISAR        ELSA       19   22114087919          07/25/2023           1      $185.00     $130.20
    014267-54                102080764001 170683398  STRAZISAR        JESSICA    18   22113935081          07/20/2023           1      $200.00     $100.00
    014267-54                102080764001 170683398  STRAZISAR        ELSA       19   22114087919          07/25/2023           1       $40.00       $4.95
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1       $96.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1       $23.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   235706750946733401   07/26/2023          25       $42.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1       $67.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1      $108.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   406627729842353401   07/27/2023          30      $104.52       $0.00

                                                                                                                                              PAGE:12 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   172914943846733401   07/26/2023          30       $67.65       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   240174513918733401   07/26/2023          30      $112.40       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   485736854556733401   07/26/2023          28       $20.83       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   715477829577733401   07/26/2023          30       $98.55       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   14234294742353401    07/26/2023         (30)   ($112.40)       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1      $167.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   22713975685          07/19/2023           1       $67.00       $0.00
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   800357809377733401   07/26/2023          30       $41.18       $0.00
    014267-54                122307690001 171640335  WIEGAND          DYANNA     01   22313819000          06/24/2022           1      $165.66       $0.00
    014267-54                122307690001 171640335  WIEGAND          DYANNA     01   22313819000          06/24/2022           1        $4.00       $0.00
    014267-54                122307690001 171640335  WIEGAND          AARON      18   939907799634153401   07/27/2023          30      $603.59       $0.00
    014267-54                122307690001 171640335  WIEGAND          AARON      18   45297836144153401    07/27/2023          30      $249.81       $0.00
    014267-54                102159846001 171648736  PALKO            MONICA     18   22032527924          07/18/2023           1       $12.00       $4.00
    014267-54                102159846001 171648736  PALKO            MONICA     18   22032527924          07/18/2023           1      $200.00     $100.00
    014267-54                102159846001 171648736  PALKO            MONICA     18   22032928877          07/18/2023           1       $64.00      $24.46
    014267-54                102159846001 171648736  PALKO            MONICA     18   22032527924          07/18/2023           1       $12.00       $4.00
    014267-54                102223852001 172547027  ALBRIGHT         TERRY      18   338621380519662401   07/22/2023          80       $25.50       $0.00
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   186795591590482401   07/23/2023          30      $187.71      $47.98
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22814043194          07/24/2023           1      $195.00      $74.94
    014267-54                116625941001 183628434  LITZINGER        VIVIAN     19   22813827721          07/20/2023           1       $40.00       $4.95
    014267-54                116625941001 183628434  LITZINGER        VIVIAN     19   22813827721          07/20/2023           1       $35.00      $16.70
    014267-54                116625941001 183628434  LITZINGER        VIVIAN     19   22813827721          07/20/2023           1      $185.00     $116.03
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   56002471810992401    07/24/2023          14       $41.55       $8.94
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22314030406          07/24/2023           1       $42.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22313815160          07/20/2023           1       $42.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   839037866147582401   07/10/2023         (30)   ($142.46)       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   373156339867613401   07/25/2023          30      $142.46       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22314030406          07/24/2023           1       $82.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        AVA        19   22314162971          07/26/2023           1      $195.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22313815160          07/20/2023           1       $82.00       $0.00
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22514182840          03/09/2023           1      $640.00     $424.80
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249212          07/24/2023           1       $23.00       $0.00

                                                                                                                                              PAGE:13 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249212          07/24/2023           1      $108.00      $27.19
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249213          07/24/2023           1       $48.00      $58.59
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249212          07/24/2023           1      $127.00      $15.55
    014267-54                103379738001 186625394  RHINE            HEIDI      19   865237829548872401   07/23/2023          90      $395.50      $23.62
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249213          07/24/2023           1      $497.00     $225.44
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22514249212          07/24/2023           1       $67.00      $20.00
    014267-54                103601525001 189448405  LAUER            CHERYL     18   147207989604303401   07/24/2023          30      $138.75       $0.00
    014267-54                103601525001 189448405  LAUER            CHERYL     18   707849635710692401   07/24/2023          30      $121.43       $5.48
    014267-54                103601525001 189448405  LAUER            CHERYL     18   30742591610692401    07/24/2023          30       $12.32       $0.00
    014267-54                103884128001 192564580  ALEXANDER        EDWARD     18   22814070244          07/24/2023           1      $211.00       $0.00
    014267-54                103884128001 192564580  ALEXANDER        EDWARD     18   686208604438153401   07/27/2023          30       $80.49       $0.00
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513836351          07/14/2023           1      $130.00     $124.83
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513836351          07/14/2023           1        $6.00       $4.95
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513836351          07/14/2023           1       $10.00       $9.07
    014267-54                104054990001 194546961  KANICH           AMY        01   22513842651          05/30/2023           1      $330.00     $157.86
    014267-54                104054990001 194546961  KANICH           AMY        01   440336934349713401   07/25/2023          14      $270.23      $13.65
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513836351          07/14/2023           1       $77.00      $69.93
    014267-54                104241017001 196668222  BORING           KAYLA      19   250982861550992401   07/24/2023          30       $30.70       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   970976490550992401   07/24/2023          30      $170.68       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   22214230708          07/24/2023           1       $41.00       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   896137607604043401   07/24/2023         (30)    ($29.80)       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   42124143550992401    07/24/2023          30       $29.80       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   22214230708          07/24/2023           1       $36.00       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   974497043773253401   07/27/2023          30       $32.91       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   22214141477          07/23/2023           1       $14.00       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   22214141477          07/23/2023           1      $292.00       $0.00
    014267-54                104241017001 196668222  BORING           KAYLA      19   22214141477          07/23/2023           1       $53.00       $0.00
    014267-54                104322714001 197666714  ZAMBONI          KATE       01   144754831417053401   07/27/2023          28       $42.98      $19.05
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   22613869286          07/12/2023           1      $142.00      $72.85
    014267-54                117170403001 197701125  BARELICH         RIVER      19   22613843831          07/20/2023           1      $140.00      $89.99
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   22614180653          07/24/2023           1      $211.00      $90.10
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   22513955682          07/20/2023           1      $108.00      $27.19

                                                                                                                                              PAGE:14 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   22513955682          07/20/2023           1       $67.00      $34.47
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   22513955682          07/20/2023           1       $23.00       $0.00
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   22513955682          07/20/2023           1      $138.00      $49.71
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   22513955682          07/20/2023           1       $67.00      $20.00
    014267-54                104402015001 198667995  KOSS             SHANNON    18   22814253462          07/24/2023           1       $66.00      $11.87
    014267-54                104402015001 198667995  KOSS             SAMANTHA   19   73311584872653401    06/23/2023         (30)   ($112.63)    ($11.11)
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22613925361          07/11/2023           1      $141.00      $93.13
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22613925361          07/11/2023           1      $128.00      $78.50
    014267-54                104402015001 198667995  KOSS             SAMANTHA   19   280457576772653401   06/23/2023         (30)   ($120.75)    ($10.52)
    014267-54                104402015001 198667995  KOSS             SHANNON    18   443582770366053401   07/27/2023           2       $70.67       $4.66
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22613925361          07/11/2023           1      $141.00      $93.13
    014267-54                104402015001 198667995  KOSS             SUMMER     19   194685481961713401   07/25/2023          30      $107.19       $8.76
    014267-54                104402015001 198667995  KOSS             SHANNON    18   22813983293          07/18/2023           1       $66.00      $11.87
    014267-54                104402015001 198667995  KOSS             SAMANTHA   19   981241534872653401   06/23/2023         (30)   ($213.63)    ($10.14)
    014267-54                104402015001 198667995  KOSS             SAMANTHA   19   180471548972653401   06/23/2023         (28)    ($57.17)    ($14.92)
    014267-54                104402015001 198667995  KOSS             SHANNON    18   335090161823433401   07/26/2023          30       $61.29      $18.48
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22613925361          07/11/2023           1      $132.00      $67.35
    014267-54                104402015001 198667995  KOSS             SUMMER     19   538616664754583401   07/29/2023          21       $44.38      $14.74
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   388962841338333401   07/26/2023          30      $159.01       $8.23
    014267-54                104472618001 199605677  RHOADES          SHERRIE    01   796527863054163401   07/28/2023          90      $206.50      $50.18
    014267-54                104536194001 200467259  MULATO           ANDREW     18   752162301998513401   07/25/2023          30      $148.61       $7.92
    014267-54                104536194001 200467259  MULATO           JUDITH     01   22614084315          07/24/2023           2      $170.00      $54.80
    014267-54                104536194001 200467259  MULATO           JUDITH     01   22614084315          07/24/2023           1      $115.00      $83.63
    014267-54                104536194001 200467259  MULATO           ANDREW     18   305717009977513401   07/25/2023          30      $323.94      $52.31
    014267-54                104536194001 200467259  MULATO           ANDREW     18   22614180486          07/25/2023           1      $209.00     $126.85
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22813964699          07/15/2023           2       $55.00       $0.00
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22813964699          07/15/2023           1      $637.00       $0.00
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22813964699          07/15/2023           1      $429.00       $0.00
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22813964699          07/15/2023           1       $35.75       $0.00
    014267-54                104717677001 202546801  CHUHRAN          COLE       19   851076330718733401   07/20/2023         (30)   ($664.60)   ($430.49)
    014267-54                104717677001 202546801  CHUHRAN          RONALD     01   22414116971          07/24/2023           1       $50.00      $24.58
    014267-54                104717677001 202546801  CHUHRAN          RONALD     01   22414116971          07/24/2023           1       $80.00      $33.32

                                                                                                                                              PAGE:15 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104717677001 202546801  CHUHRAN          RONALD     01   22414116971          07/24/2023           1       $50.00      $27.40
    014267-54                104717677001 202546801  CHUHRAN          RONALD     01   22414116971          07/24/2023           1      $115.00      $68.94
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   22414106801          07/24/2023           1       $36.00      $18.17
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   22414106801          07/24/2023           1      $206.00     $118.88
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           1      $102.23      $73.36
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023          20       $67.65       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1        $5.82       $0.00
    014267-54                104738058001 202684807  REPINE           MARK       01   22029343583          05/30/2023          (1)   ($261.00)       $0.00
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           1       $62.13      $47.93
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032744585          07/11/2023           1      $135.00      $70.92
    014267-54                104738058001 202684807  REPINE           MARK       01   22032735149          07/03/2023           1      $961.00     $350.88
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032839456          07/21/2023           1      $395.00     $305.03
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           2       $12.27       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1      $494.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1       $17.97       $0.00
    014267-54                104738058001 202684807  REPINE           MARK       01   22032735149          07/03/2023           1      $378.00     $291.58
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           2        $9.52       $6.60
    014267-54                104738058001 202684807  REPINE           MARK       01   22032758445          07/03/2023           1      $130.00      $78.61
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1    $3,880.00   $2,612.75
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           1      $194.30     $135.36
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1      $727.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           2       $23.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           1       $24.36       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           4        $2.44       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032918744          07/21/2023           4        $1.22       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032575951          07/22/2023           1      $240.00     $178.53
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           1       $60.52      $25.42
    014267-54                104738058001 202684807  REPINE           MARK       01   22032833658          07/20/2023           1       $30.11      $21.60
    014267-54                104788273001 203482794  PALKO            DANIEL     18   828172471475353401   07/27/2023          30       $76.04       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22814072186          07/24/2023           1        $7.00       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22814072186          07/24/2023           1      $135.00       $0.00
    014267-54                126258506001 207609840  KIRSCH           KYLIE      19   22814072185          07/24/2023           1      $135.00       $0.00

                                                                                                                                              PAGE:16 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   754697826777303401   07/24/2023           3       $28.86       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   432982041110303401   07/24/2023           5       $36.35       $0.00
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   370514883338763401   07/28/2023          30      $174.20       $6.89
    014267-54                105312729001 209560824  LAUER            MARIA      18   731459155597903401   07/25/2023          90      $112.00      $25.09
    014267-54                105312729001 209560824  LAUER            MARIA      18   416347849597903401   07/25/2023          90      $118.30      $14.11
    014267-54                105312729001 209560824  LAUER            MARIA      18   810912541597903401   07/25/2023          90      $825.01      $28.58
    014267-54                105312729001 209560824  LAUER            GENO       19   22313938557          07/21/2023           1      $160.00     $124.48
    014267-54                105312729001 209560824  LAUER            GENO       19   22313938557          07/21/2023           1      $175.00     $105.99
  014267-54 Total                                                                                                                   $30,928.35  $12,175.52
  014267- Total                                                                                                                     $30,928.35  $12,175.52
  017697-00
    017697-00                101289752001 160587191  CLAAR            KENDALL    19   641154564850333401   07/26/2023          91      $305.94      $24.01
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/26/2023           1       $35.00      $10.45
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/24/2023           1       $50.00      $33.32
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/24/2023           1       $35.00      $10.45
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/26/2023           1       $50.00      $33.32
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/24/2023           1       $65.00      $45.97
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/24/2023           1       $50.00      $45.58
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114125485          07/25/2023           1      $205.00      $93.93
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114155369          07/24/2023           1      $130.00     $105.99
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22114125485          07/25/2023           1       $95.00      $72.85
    017697-00                116893538001 164669255  WALTERS          TRAVIS     01   861157719137743401   07/27/2023          30      $121.43       $5.48
    017697-00                116893538001 164669255  WALTERS          AMY        18   388608584427743401   07/27/2023          30      $135.60       $9.88
    017697-00                128881676001 164765283  LEAHEY           BRIANNA    01   22202937943          02/03/2023           1      $142.00      $85.70
    017697-00                118886334001 165662521  MENTO            JACQUELY   18   110886839287582401   07/23/2023           6       $35.64      $12.54
    017697-00                102072716001 170622250  MCCOMBIE         CHRISTIN   01   592312491753583401   07/29/2023          28       $35.96      $13.04
    017697-00                102072716001 170622250  MCCOMBIE         ALAYNA     19   128172101873613401   07/25/2023          30       $54.99       $0.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213950634          05/26/2023           1    $2,050.00     $250.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22214183167          06/14/2023           1      $342.00      $98.91
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213950634          05/26/2023          18      $396.00     $207.72
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   984580391676433401   07/26/2023          90      $427.22      $19.66
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   628868854614992401   07/24/2023           7       $20.63       $4.49

                                                                                                                                              PAGE:17 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22214183167          06/14/2023           1      $446.00     $200.27
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   289987563059633401   07/26/2023          30      $137.71       $0.00
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   248177529993153401   07/27/2023          30       $10.50       $1.09
    017697-00                113204987001 176509888  DORSCH           CHRISTIN   18   427377999693733401   07/26/2023          30       $71.98       $0.00
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   42816400949633401    07/26/2023          30      $217.84       $0.00
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   62527656159633401    07/26/2023          30       $48.69       $0.00
    017697-00                113204987001 176509888  DORSCH           CHRISTIN   18   97017817593733401    07/26/2023          30      $155.70       $0.00
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   817576450793153401   07/27/2023          30      $443.72       $0.00
    017697-00                113204987001 176509888  DORSCH           CHRISTIN   18   144447167449633401   07/26/2023          30      $105.29       $0.00
    017697-00                113204987001 176509888  DORSCH           DANIEL     01   15592484949633401    07/26/2023          30       $41.48       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22614147334          07/24/2023           1       $30.00       $5.14
    017697-00                102742521001 178682192  WHEELER          JUSTIN     18   249256549607892401   07/24/2023          30      $217.84       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22614147334          07/24/2023           1      $141.00     $112.97
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22614147334          07/24/2023           1        $8.00       $5.50
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22614147334          07/24/2023           1       $30.00      $26.70
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22614147334          07/24/2023           1        $8.00       $5.00
    017697-00                102742521001 178682192  WHEELER          HAYLEY     19   192967439213913401   07/25/2023           5       $51.71       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   679796229400203401   07/24/2023           2      $602.80       $0.00
    017697-00                102884338001 180600186  LEARN            CRAIG      01   22113935073          07/15/2023           1       $49.00      $20.20
    017697-00                102884338001 180600186  LEARN            CRAIG      01   22113935073          07/15/2023           1       $84.00       $0.00
    017697-00                102884338001 180600186  LEARN            CRAIG      01   22113935073          07/15/2023           1       $52.00      $35.15
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22213789254          07/20/2023           1       $40.00      $21.21
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22213789254          07/20/2023           1       $40.00      $10.96
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22213789254          07/20/2023           1      $350.00     $292.66
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22213789254          07/20/2023           1      $185.00     $119.36
    017697-00                123414108001 183723909  MCMULLEN         JOCELYN    18   22614183663          07/25/2023           1      $916.08       $0.00
    017697-00                123414108001 183723909  MCMULLEN         JOCELYN    18   22614183663          07/25/2023           1      $375.00       $0.00
    017697-00                123414108001 183723909  MCMULLEN         JOCELYN    18   22614183663          07/25/2023           1      $332.52       $0.00
    017697-00                123414108001 183723909  MCMULLEN         JOCELYN    18   22614183663          07/25/2023           1      $588.24       $0.00
    017697-00                103219751001 184660196  CHERICO          JESSICA    18   256854784417892401   07/24/2023          30       $47.27       $0.00
    017697-00                103299423001 185646090  NILESKI          STEPHEN    01   411366354298182401   07/23/2023          30       $32.91       $6.39
    017697-00                103299423001 185646090  NILESKI          KERRY      18   22614146703          02/07/2023           2       $58.00      $56.48

                                                                                                                                              PAGE:18 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                115603314001 187702712  MARINO           AMANDA     18   447017719274333401   07/26/2023          28      $186.40     $128.18
    017697-00                128188608001 187709950  LANE             LYDIA      19   22614269871          07/19/2023           1      $210.00     $119.36
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   125542194665292401   07/24/2023          81      $211.90     $144.03
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   22113992091          07/19/2023           1      $100.00      $41.08
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   22113992091          07/19/2023           1      $220.00     $109.89
    017697-00                103799754001 191568518  GIBSON           AMY        18   3714703722733401     07/26/2023           5        $5.65       $0.00
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314001096          07/24/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313783329          07/20/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             MICHAEL    01   256527096700692401   07/24/2023          30       $53.67       $3.96
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313783329          07/20/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314009392          07/25/2023           1       $15.00      $11.87
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314009392          07/25/2023           1       $42.00      $33.32
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313783329          07/20/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313783329          07/20/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314009392          07/25/2023           1       $27.00      $24.58
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314009392          07/25/2023           1       $15.00      $10.45
    017697-00                103977327001 193622433  SHOW             MICHAEL    01   216426714700692401   07/24/2023          30      $221.07      $25.24
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314001096          07/24/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314001096          07/24/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22314001096          07/24/2023           2      $141.00      $49.16
    017697-00                122764620001 194708330  MONTAG           LUKE       19   923177737479833401   07/26/2023          10       $10.48       $0.00
    017697-00                122764620001 194708330  MONTAG           LUKE       19   166699185673123401   07/25/2023          10       $44.49       $0.00
    017697-00                122764620001 194708330  MONTAG           LUKE       19   22314157965          07/17/2023           1       $37.50       $0.00
    017697-00                122764620001 194708330  MONTAG           LUKE       19   22314157965          07/17/2023           1       $45.00       $0.00
    017697-00                122764620001 194708330  MONTAG           LUKE       19   22314157965          07/17/2023           1       $52.50       $0.00
    017697-00                117751540001 195663631  BARLICK          SARAH      18   774698734049963401   07/28/2023          30    $2,179.00      $28.22
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22414059997          07/19/2023         300   $15,600.00   $8,868.00
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22414059997          07/19/2023           1      $196.00     $100.88
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22414059999          07/19/2023           1      $254.00     $110.90
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714173563          06/30/2023           1       $15.00       $9.64
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714200673          07/24/2023           2      $172.00      $45.20
    017697-00                104228854001 196584813  FARREN           HEATHER    18   679054494788182401   07/23/2023          30      $159.01       $8.23

                                                                                                                                              PAGE:19 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                104228854001 196584813  FARREN           HEATHER    18   182356359417892401   07/24/2023          28        $1.38       $1.05
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714173563          06/02/2023           1       $15.00       $9.64
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714173563          06/23/2023           1       $15.00       $9.64
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714200673          07/24/2023           1       $97.00      $28.53
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714173563          06/16/2023           1       $15.00       $9.64
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714072425          07/25/2023           1      $110.00      $73.34
    017697-00                104228854001 196584813  FARREN           HEATHER    18   539545021462613401   07/25/2023          30       $21.22      $11.44
    017697-00                104228854001 196584813  FARREN           HEATHER    18   571405841888182401   07/23/2023          30      $174.20       $8.54
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713912437          07/20/2023           1       $97.00      $28.53
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714070614          02/14/2023           1      $220.82      $97.94
    017697-00                104228854001 196584813  FARREN           HEATHER    18   846417597421782401   07/23/2023          30       $93.17      $21.57
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713896543          07/15/2023           1      $426.00     $248.43
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713912437          07/20/2023           2      $172.00      $45.20
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714173563          06/09/2023           1       $15.00       $9.64
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713912437          07/20/2023           1       $87.00      $24.58
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714072426          07/25/2023           1       $40.00      $21.60
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22714200673          07/24/2023           1       $87.00      $24.58
    017697-00                104325873001 197689597  SMORTO           TYLER      19   22613917735          07/22/2023           1      $240.00       $0.00
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   555684364003603401   07/22/2023         (30)   ($129.21)     ($5.59)
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313976207          07/12/2023           1      $295.00     $282.43
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   992347076003603401   07/22/2023          30      $129.21       $5.59
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   637996164792603401   07/22/2023         (30)   ($172.93)     ($8.54)
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313976207          07/12/2023           1      $175.00     $123.65
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   830617729373913401   07/22/2023         (30)   ($172.93)     ($8.54)
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   297826230373913401   07/22/2023          30      $174.20       $8.54
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   337200961792603401   07/22/2023          30      $172.93       $8.54
    017697-00                104568282001 200683607  RAKAR            TAMARA     18   22032657588          07/20/2023           1      $200.00     $100.00
    017697-00                104731674001 202628913  SHERRY           SCOTT      18   879905101253173401   07/28/2023          30      $155.97       $0.00
    017697-00                104731674001 202628913  SHERRY           SCOTT      18   8354094502273401     07/28/2023          30       $74.39       $0.00
    017697-00                104810347001 203609555  HALE             LEWIS      18   22113906058          07/12/2023           1       $45.00      $33.32
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22713999275          07/19/2023           1       $80.00       $0.00
    017697-00                116320743001 206664225  DRENNING         EMMA       19   22032714572          06/26/2023           1       $80.00       $0.00

                                                                                                                                              PAGE:20 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                116320743001 206664225  DRENNING         EMMA       19   22032714572          06/26/2023           1      $200.00       $0.00
    017697-00                128450687001 207721532  SCHLUEP          JESSICA    01   22513876053          07/17/2023           1      $102.00      $53.70
    017697-00                128450687001 207721532  SCHLUEP          JESSICA    01   847634071150783401   07/29/2023           5      $181.51       $7.13
    017697-00                128450687001 207721532  SCHLUEP          JESSICA    01   22513876053          07/17/2023           1       $23.00       $0.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813961952          07/19/2023           1      $250.00      $11.97
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814088940          07/19/2023           1      $172.00       $0.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814088940          07/19/2023           1      $279.00     $201.96
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814174024          07/24/2023           6      $336.00     $115.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814064176          07/19/2023           1      $150.00      $12.36
    017697-00                105299927001 209482347  DELANEY          MEGAN      19   907991128040963401   07/28/2023          30      $148.61       $9.88
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814174024          07/24/2023           1       $60.00       $0.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22814131303          07/19/2023           1      $220.00     $109.89
    017697-00                111665958001 210543123  TEREK            KIMBERLY   01   362817767722892401   07/24/2023          30       $29.80       $0.00
    017697-00                111665958001 210543123  TEREK            DANIEL     19   942560491722892401   07/24/2023          30      $380.26       $0.00
    017697-00                111665958001 210543123  TEREK            DANIEL     19   409340521822892401   07/24/2023          30      $217.72       $0.00
  017697-00 Total                                                                                                                   $37,234.68  $13,886.84
  017697-01
    017697-01                101514236001 163541163  ARFORD           MARYLOU    18   183227096187333401   07/26/2023          28    $4,916.74   $4,163.99
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   22714228432          07/26/2023           1      $346.00     $174.07
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   22714228432          07/26/2023           2      $194.28      $99.84
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   22714228432          07/26/2023           1      $195.74      $50.09
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   22714228432          07/26/2023           1      $109.30      $53.48
    017697-01                102056797001 170523784  NOLL             VERONICA   18   164239195255713401   07/25/2023          28    $1,357.49     $901.89
    017697-01                102056797001 170523784  NOLL             VERONICA   18   22114016419          07/21/2023           1      $120.00      $47.13
    017697-01                102056797001 170523784  NOLL             VERONICA   18   22114016419          07/21/2023           1      $215.00      $85.70
    017697-01                102730783001 178600938  STASIK           MELANIE    19   22414051336          07/21/2023           1      $145.00     $110.01
    017697-01                102730783001 178600938  STASIK           MELANIE    19   22414051336          07/14/2023           1      $145.00     $110.01
    017697-01                102730783001 178600938  STASIK           ROBERT     01   498954913650333401   07/26/2023          30      $214.84      $10.05
    017697-01                123974890001 183501025  KALWASINSKI      BRENDA     18   488576864302913401   07/25/2023           6      $217.71       $0.00
    017697-01                103203813001 184560258  HODGSON          KAREN      18   22314000574          07/20/2023           1      $150.00       $0.00
    017697-01                103203813001 184560258  HODGSON          KAREN      18   22314000574          07/20/2023           1      $316.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   392857356592053401   07/27/2023          30      $260.67       $8.50

                                                                                                                                              PAGE:21 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   120465351692053401   07/27/2023          16      $369.77      $10.03
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22514019819          07/19/2023           1      $220.00     $109.89
    017697-01                114851571001 193484912  LAPPI            ROBIN      18   90796964950333401    07/26/2023          30      $165.74       $0.00
    017697-01                114851571001 193484912  LAPPI            ROBIN      18   72934903950333401    07/26/2023          30       $46.03       $0.00
    017697-01                105488486001 211561897  YINGLING         NANCY      01   22814131604          07/21/2023           1       $20.00       $0.00
    017697-01                105488486001 211561897  YINGLING         NANCY      01   485244923926892401   07/24/2023          30      $122.42       $5.48
    017697-01                105488486001 211561897  YINGLING         NANCY      01   22813820535          07/17/2023           1      $127.00     $126.32
    017697-01                134182676001 211741514  THOMAS           KIMBERLY   18   22213991317          07/20/2023           1      $531.00     $249.77
    017697-01                134182676001 211741514  THOMAS           KIMBERLY   18   22213776910          07/17/2023           1      $130.00      $51.19
    017697-01                134182676001 211741514  THOMAS           KIMBERLY   18   22213991317          07/20/2023           1      $809.00     $410.49
    017697-01                134182676001 211741514  THOMAS           KIMBERLY   18   22213776910          07/17/2023           1      $184.00      $87.64
    017697-01                134182676001 211741514  THOMAS           KIMBERLY   18   22213776910          07/17/2023           1       $31.00       $0.00
  017697-01 Total                                                                                                                   $11,659.73   $6,865.57
  017697-10
    017697-10                117140617001 165402030  HABER            PAUL       18   22114022680          07/24/2023           1      $210.00      $88.00
  017697-10 Total                                                                                                                      $210.00      $88.00
  017697-70
    017697-70                102057668001 170526421  LENZ             SALLY      18   22814130970          07/10/2023           1      $105.00      $77.03
  017697-70 Total                                                                                                                      $105.00      $77.03
  017697- Total                                                                                                                     $49,209.41  $20,917.44
  017728-00
    017728-00                101458722001 162684710  WEAKLAND         JAMIE      01   533492904156833401   07/26/2023           7       $21.97       $0.00
    017728-00                135777913001 167765803  RODKEY           BRITTANY   18   193515591307433401   07/26/2023          20      $142.45       $0.00
    017728-00                135777913001 167765803  RODKEY           BRITTANY   18   507049315540813401   07/25/2023          28      $102.30      $15.13
    017728-00                102646677001 177602042  HOCKENBERRY      ALLEN      01   374091524486653401   07/27/2023          30      $148.61       $9.88
    017728-00                102646677001 177602042  ABEL             BRYAN      19   662994673741103401   07/24/2023          30        $9.13       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22314086544          07/19/2023           1      $201.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22314086544          07/19/2023           1      $200.00     $161.39
    017728-00                102646677001 177602042  ABEL             KELLY      18   22314086544          07/19/2023           1    $3,100.00   $1,400.27
    017728-00                102646677001 177602042  ABEL             KELLY      18   22314176568          07/19/2023           1      $277.00      $88.20
    017728-00                102646677001 177602042  ABEL             KELLY      18   22314096202          07/19/2023           1      $125.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22313936394          07/19/2023           1      $818.00       $0.00

                                                                                                                                              PAGE:22 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017728-00                113594013001 180509497  TEETER           PAULA      01   22032764835          07/19/2023           1      $521.00     $363.52
    017728-00                113594013001 180509497  TEETER           PAULA      01   22032635666          07/19/2023           1      $150.00       $9.27
    017728-00                113594013001 180509497  TEETER           PAULA      01   22032764835          07/19/2023           1      $349.00     $356.95
    017728-00                113594013001 180509497  TEETER           PAULA      01   22032527957          07/19/2023           1      $124.00      $85.54
    017728-00                113594013001 180509497  TEETER           PAULA      01   508806104750633401   07/26/2023           5       $23.50       $4.72
    017728-00                113594013001 180509497  TEETER           PAULA      01   22032764835          07/19/2023           1      $239.00     $128.19
    017728-00                103807190001 191609569  PARONISH         ANDREW     18   22213812183          07/21/2023           1      $120.00     $110.01
    017728-00                114875891001 204664917  LUTHER           RENEE      01   22813838772          07/20/2023           1      $130.00       $0.00
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   397486764400453401   07/27/2023          30       $15.00       $9.88
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   422421518909583401   07/27/2023         (30)     ($7.41)     ($7.41)
    017728-00                115593107001 208604479  HARR             MATTHEW    18   644654904778482401   07/23/2023          30      $166.67       $7.20
    017728-00                115593107001 208604479  HARR             MATTHEW    18   369922144689023401   07/25/2023          30      $166.67       $7.20
    017728-00                115593107001 208604479  HARR             MATTHEW    18   532597709689023401   07/23/2023         (30)   ($166.67)     ($7.20)
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   900636749909583401   07/29/2023          30        $7.41       $7.41
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   22513965372          07/14/2023           1      $150.00      $56.00
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   646754741388583401   07/27/2023         (30)    ($15.00)     ($9.88)
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   173004084388583401   07/29/2023          30       $15.00       $9.88
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   22513964909          07/20/2023           1      $175.35     $137.72
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   22513964909          07/20/2023           1      $172.00     $105.99
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   106977189194453401   07/27/2023          30        $7.41       $7.41
    017728-00                115593107001 208604479  HARR             MATTHEW    18   22513961392          07/17/2023           1      $143.00      $41.31
    017728-00                115941556001 210707006  LOWMASTER        CLAIRE     18   325796424221382401   07/23/2023          31       $14.50       $0.00
  017728-00 Total                                                                                                                    $7,645.89   $3,098.58
  017728- Total                                                                                                                      $7,645.89   $3,098.58
  104272-02
    104272-02                101295757001 160624529  HOOVER           MILEY      19   22114177322          07/25/2023           1      $220.00       $0.00
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22113771891          07/12/2023           1       $56.00       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        NICHOLAS   01   22031995393          06/12/2023           1      $529.00     $306.00
    104272-02                101376005001 161646259  DAUBERT          NADIA      19   22514136774          07/24/2023           1      $119.00     $119.00
    104272-02                101376005001 161646259  DAUBERT          NADIA      19   22514136774          07/24/2023           1       $25.00      $20.20
    104272-02                101376005001 161646259  DAUBERT          NADIA      19   22514136774          07/24/2023           1      $142.00     $142.00
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1      $306.00     $306.00

                                                                                                                                              PAGE:23 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1       $15.00      $15.00
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1       $12.00      $10.96
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1       $27.00      $21.21
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1       $37.00      $35.55
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   22813856081          07/14/2023           1      $105.00     $105.00
    104272-02                116841081001 161743781  PARTSCH          SUSAN      18   22313811837          05/18/2023           1       $95.00       $0.00
    104272-02                101437249001 162546576  CARBONARA        THERESA    18   22414152115          07/25/2023           1      $205.00     $101.05
    104272-02                101437249001 162546576  CARBONARA        THERESA    18   203722324674813401   07/25/2023          30      $278.25     $160.58
    104272-02                101437249001 162546576  CARBONARA        THERESA    18   22414152115          07/25/2023           1       $95.00      $72.85
    104272-02                101448839001 162609446  MARTIN           NICOLE     18   27304583283223401    07/25/2023          10      $128.80      $16.29
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   294409455916892401   07/24/2023          30      $213.63       $7.95
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   954440411916892401   07/24/2023          21       $44.38      $14.74
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713853645          07/13/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22714164324          07/21/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713853645          07/13/2023           2      $172.00      $49.16
    104272-02                121084549001 162722491  GEORGE           JARED      18   22714164324          07/21/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713853645          07/13/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22714164324          07/21/2023           1       $86.00      $24.58
    104272-02                101607826001 164645212  STOHON           NATHAN     18   22413925095          07/20/2023           1       $45.00       $0.00
    104272-02                101607826001 164645212  STOHON           NATHAN     18   22413693056          07/17/2023           1       $45.00       $0.00
    104272-02                126386044001 164702873  JEFFERSON        BOBBI      01   319542731343253401   07/27/2023          10       $19.68       $8.09
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   22714040193          07/21/2023           1      $126.00     $102.70
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   710006824528603401   07/24/2023          30      $177.95     $120.39
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   894772691699533401   07/26/2023          30      $345.74     $277.40
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   22714040193          07/21/2023           1       $21.00       $8.00
    104272-02                119564703001 164728504  HILDEBRAND       ALEX       19   22032632989          07/21/2023           1      $160.00     $126.85
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113838083          07/16/2023           1      $831.00     $100.71
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   245581664198753401   07/27/2023          30      $681.99     $540.75
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22114022993          07/16/2023           1      $362.76     $184.60
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113838084          07/16/2023           1      $250.00      $11.97
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22614072008          07/25/2023           1       $45.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22614255271          07/27/2023           1       $45.00       $0.00

                                                                                                                                              PAGE:24 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                135710323001 165723208  RANCK            NOLAN      19   687857746955753401   07/27/2023          30      $703.99     $527.05
    104272-02                135710323001 165723208  RANCK            LANDON     19   789016924399413401   07/25/2023          25      $269.99     $163.28
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $65.00      $39.89
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           2      $130.00      $66.43
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $70.00      $61.51
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22713886984          07/18/2023           1    $1,370.00     $101.10
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1    $3,409.00   $1,126.35
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $91.00      $48.46
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           3      $144.00     $145.39
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $56.00      $82.50
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $48.00      $41.48
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023          72      $200.35      $25.92
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $91.00      $65.50
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1      $119.00      $61.51
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $56.00      $34.29
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1      $424.00      $54.21
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           2      $112.00     $165.00
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22714088786          07/18/2023           1       $48.00      $48.46
    104272-02                118725577001 165747588  BODENSCHATZ      MAX        01   22714173561          06/09/2023           1        $8.00       $3.25
    104272-02                118725577001 165747588  BODENSCHATZ      LAUREN     18   22714173560          06/09/2023           1        $8.00       $3.25
    104272-02                118725577001 165747588  BODENSCHATZ      FRANKIE    19   22714042793          07/24/2023           1       $40.00      $10.96
    104272-02                118725577001 165747588  BODENSCHATZ      FRANKIE    19   22714042793          07/24/2023           1      $185.00     $119.36
    104272-02                101838197001 167645469  PERSIO           LILY       19   226961104169963401   07/28/2023          28      $186.01      $13.70
    104272-02                101838197001 167645469  PERSIO           ELLA       19   982581438259963401   07/28/2023          28      $186.01      $13.70
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $132.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023          (1)   ($132.00)       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023          (1)    ($14.00)       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $125.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $132.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023          (1)   ($132.00)       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $125.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1       $14.00       $0.00

                                                                                                                                              PAGE:25 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   22032635664          07/19/2023           1      $358.00      $30.99
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   22032635664          07/19/2023           1      $715.00      $38.56
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   22032650354          07/19/2023           1       $48.00      $58.59
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   22032650354          07/19/2023           1      $497.00     $225.44
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   122004943817743401   07/27/2023          30      $158.01       $8.23
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   574772654345053401   07/27/2023          30       $74.62      $10.81
    104272-02                101903657001 168543440  WEILAND          JAMES      18   820297297020692401   07/24/2023          30      $268.35      $10.28
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   321542471120692401   07/24/2023          30       $79.80      $12.93
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   703457487020692401   07/24/2023          30      $244.27      $45.61
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   22714316936          07/20/2023           2       $94.00      $45.20
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   22714223490          07/05/2023           1      $150.00      $85.70
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   22714223490          07/05/2023           1       $47.00      $10.50
    104272-02                101918329001 168627615  MCCOMBIE         KENNETH    19   22714223496          07/05/2023           1      $225.00     $105.99
    104272-02                101918687001 168628770  STEVENS          MELISSA    18   22513955681          07/18/2023           1      $497.00     $225.44
    104272-02                101918687001 168628770  STEVENS          MELISSA    18   22513955680          07/18/2023           1      $397.00     $248.43
    104272-02                101918687001 168628770  STEVENS          MELISSA    18   22513955681          07/18/2023           1       $48.00      $58.59
    104272-02                101918687001 168628770  STEVENS          MELISSA    18   22513866884          07/18/2023           1      $358.00      $30.99
    104272-02                101918687001 168628770  STEVENS          MELISSA    18   22513866884          07/18/2023           1      $715.00      $38.56
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   171346979671053401   07/26/2023         (30)   ($359.71)   ($208.33)
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   261727049574023401   07/24/2023         (30)   ($359.71)   ($208.33)
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   784887117771053401   07/27/2023          30      $359.71     $208.33
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   435957913607003401   07/24/2023          30      $359.71     $208.33
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   677785761619933401   07/26/2023          30      $359.71     $208.33
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213817765          07/14/2023           1      $130.00     $124.83
    104272-02                101993438001 169628033  BALL             SETH       19   631254634389503401   07/11/2023         (20)    ($49.15)       $0.00
    104272-02                101993438001 169628033  BALL             CARLEEN    18   254655871567892401   07/24/2023          30       $67.16       $0.00
    104272-02                101993438001 169628033  BALL             SETH       19   44079835800603401    07/11/2023          (7)    ($84.03)       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213817765          07/14/2023           1        $6.00       $4.95
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   661840501885713401   07/25/2023          30      $212.49      $36.95
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   758196454349203401   07/24/2023          30    $1,831.05   $1,469.36
    104272-02                121615384001 170665296  ISENBERG         ALI        19   475822911744333401   07/26/2023          30       $82.42       $6.07
    104272-02                121615384001 170665296  ISENBERG         ALI        19   128684894254333401   07/26/2023          30      $315.73      $12.06

                                                                                                                                              PAGE:26 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                121615384001 170665296  ISENBERG         BREANNE    18   22414181185          07/19/2023           1       $47.00      $33.32
    104272-02                121615384001 170665296  ISENBERG         KEIRA      19   22414181189          07/19/2023           1       $47.00      $33.32
    104272-02                121615384001 170665296  ISENBERG         BREANNE    18   802956670532533401   07/26/2023          30      $240.40     $192.87
    104272-02                115236308001 171640207  GRASSI           KAREN      01   22214002008          06/26/2023           1      $150.00       $0.00
    104272-02                115236308001 171640207  GRASSI           JARED      18   22214001954          06/26/2023           1       $47.00       $0.00
    104272-02                115236308001 171640207  GRASSI           JARED      18   22214001954          06/26/2023           1      $200.00       $0.00
    104272-02                115236308001 171640207  GRASSI           KAREN      01   474291514624583401   07/29/2023          30       $48.40       $0.00
    104272-02                115236308001 171640207  GRASSI           KAREN      01   22214002008          06/26/2023           1       $47.00       $0.00
    104272-02                102243890001 172685116  KUKLA            MADISON    19   954676840000333401   07/26/2023          30       $53.92      $28.08
    104272-02                102243890001 172685116  KUKLA            DONALD     01   361916330894333401   07/26/2023          30       $13.73       $6.22
    104272-02                102243890001 172685116  KUKLA            DONALD     01   173237077404333401   07/26/2023          30       $85.31       $5.42
    104272-02                102243890001 172685116  KUKLA            DONALD     01   301194723504333401   07/26/2023          30      $111.76      $11.85
    104272-02                102243890001 172685116  KUKLA            LOGAN      19   510788554504333401   07/26/2023          30      $170.69       $9.21
    104272-02                102243890001 172685116  KUKLA            LISA       18   212756000015333401   07/26/2023          30      $208.58      $16.28
    104272-02                102243890001 172685116  KUKLA            DONALD     01   713226160366533401   07/26/2023           6       $30.14      $16.89
    104272-02                102243890001 172685116  KUKLA            DONALD     01   964797569705333401   07/26/2023          30      $142.45       $7.09
    104272-02                119564810001 172728244  SEDLOCK          BRITTANY   18   22814172957          07/19/2023           1      $289.00      $76.61
    104272-02                135851965001 172764065  LOCHER           MARISA     18   625706694104282401   07/23/2023           6       $10.45       $4.43
    104272-02                135851965001 172764065  PISCATELLO       MAYLEE     19   98674353548792401    07/24/2023          30       $80.82      $20.62
    104272-02                135851965001 172764065  PISCATELLO       MAYLEE     19   635811624693883401   07/29/2023          30      $337.92      $46.44
    104272-02                135851965001 172764065  LOCHER           MARISA     18   558566354734182401   07/23/2023          10      $106.98       $1.80
    104272-02                135851965001 172764065  LOCHER           MARISA     18   864456670455182401   07/23/2023          30      $178.76       $8.54
    104272-02                110157934001 173649775  OSTINOWSKY       JOHN       01   211317789330303401   07/24/2023          10       $80.01      $24.34
    104272-02                110157934001 173649775  OSTINOWSKY       JOHN       01   581488214509633401   07/26/2023          30       $90.85      $18.93
    104272-02                102327164001 173700970  FORCELLINI       CYDNEY     19   312217416097933401   07/26/2023          30       $36.99       $9.76
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   22814138520          07/25/2023           1      $130.00     $120.81
    104272-02                102327164001 173700970  FORCELLINI       CYDNEY     19   473446030864633401   07/26/2023          30       $85.45       $5.84
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   22814228608          07/26/2023           1       $40.00      $12.84
    104272-02                102327164001 173700970  FORCELLINI       CYDNEY     19   468405491905933401   07/26/2023          30      $478.99     $356.40
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   22814174577          07/21/2023           1       $95.00      $72.85
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   22814174577          07/21/2023           1      $205.00     $101.05
    104272-02                102403638001 174646831  GERNEY           KAYLA      19   82851098449273401    07/26/2023         (28)     ($9.00)     ($9.00)

                                                                                                                                              PAGE:27 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102403638001 174646831  GERNEY           KAYLA      19   717085031018433401   07/26/2023          28        $9.00       $9.00
    104272-02                102403638001 174646831  GERNEY           KAYLA      19   577661134549273401   07/28/2023          28        $9.00       $9.00
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   188112714665892401   07/24/2023          30       $36.21       $8.23
    104272-02                122695741001 174663939  BEDNAR           CHELSEA    19   22113935217          07/18/2023           1      $158.00     $110.01
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   881119545104333401   07/26/2023          28       $37.50      $14.86
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   486387926268763401   07/28/2023          30       $82.42       $5.84
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   764707093886053401   07/27/2023          28    $1,618.82   $1,299.85
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   216772261628733401   07/26/2023          30    $1,173.91     $917.00
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1      $105.00      $24.86
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $45.00      $15.14
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023           1      $173.53      $64.62
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $67.27      $32.73
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $50.00      $20.58
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           3      $210.00      $67.40
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1      $214.00      $57.67
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $45.00      $12.61
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1      $150.00      $41.36
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813999013          07/17/2023           1      $220.00      $92.14
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023           1    $1,098.10     $507.65
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023          (2)   ($170.00)   ($170.00)
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $77.00      $29.38
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1      $107.00      $26.56
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $16.00       $0.00
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023           1      $585.99     $203.95
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023          (1)   ($173.53)    ($64.62)
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023          (1)   ($585.99)   ($244.03)
    104272-02                102484817001 175624053  DEMI             THERESA    18   21899271341          01/04/2023           2      $170.00     $170.00
    104272-02                102484817001 175624053  DEMI             THERESA    18   22813975101          07/17/2023           1       $55.00      $13.05
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   22809429325          04/15/2023           1      $200.00      $63.06
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   22809429325          04/15/2023          (1)   ($200.00)    ($57.43)
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   22809429325          04/15/2023          (1)    ($47.00)    ($10.50)
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   22809429325          04/15/2023           1       $47.00      $10.50

                                                                                                                                              PAGE:28 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102636302001 177540502  GILLEN           JANET      18   22514018894          07/20/2023           1      $120.00      $93.40
    104272-02                102636302001 177540502  GILLEN           JANET      18   22514294007          07/17/2023           1       $18.00       $8.00
    104272-02                102636302001 177540502  GILLEN           JANET      18   22514294007          07/17/2023           1       $80.00      $28.50
    104272-02                102636302001 177540502  GILLEN           JANET      18   22514294007          07/17/2023           1       $42.00      $13.00
    104272-02                102636302001 177540502  GILLEN           JANET      18   22514018894          07/20/2023           5      $375.00      $51.45
    104272-02                102655122001 177649243  MOORE            JILL       01   3551718628763401     07/27/2023          30       $33.81       $7.64
    104272-02                102655122001 177649243  MOORE            JILL       01   707389595604753401   07/27/2023          30       $33.14       $7.64
    104272-02                102655122001 177649243  MOORE            JILL       01   22614190518          07/24/2023           1        $8.00       $3.25
    104272-02                102655122001 177649243  MOORE            DAVID      18   22613999761          06/27/2023           1       $33.00      $17.61
    104272-02                102655122001 177649243  MOORE            JILL       01   622016130520003401   07/24/2023           3       $43.61       $8.08
    104272-02                102655122001 177649243  MOORE            DAVID      18   22613999761          06/27/2023           1      $322.00     $127.26
    104272-02                102655122001 177649243  MOORE            JILL       01   22614190506          07/24/2023           1      $205.00     $101.05
    104272-02                102655122001 177649243  MOORE            JILL       01   354122530704753401   07/27/2023          30      $192.94      $17.20
    104272-02                102655122001 177649243  MOORE            JILL       01   22614190506          07/24/2023           1       $21.00      $15.73
    104272-02                102655122001 177649243  MOORE            JILL       01   878111628804753401   07/27/2023          30      $177.95      $16.28
    104272-02                102655122001 177649243  MOORE            JILL       01   173287797528763401   07/27/2023         (30)    ($33.14)     ($7.64)
    104272-02                102655122001 177649243  MOORE            JILL       01   22614190506          07/24/2023           1      $125.00      $85.00
    104272-02                114861273001 177704151  GRUDZIEN         GORDON     01   22614264586          07/24/2023           1       $30.00      $24.58
    104272-02                114861273001 177704151  GRUDZIEN         GORDON     01   22614264586          07/24/2023           1       $45.00      $23.27
    104272-02                102717987001 178523742  LEWIS            TINA       18   836294793683073401   07/28/2023          28       $13.44       $3.06
    104272-02                102717987001 178523742  LEWIS            TINA       18   583296010193073401   07/28/2023          30      $184.37       $9.32
    104272-02                102717987001 178523742  LEWIS            TINA       18   128435681483073401   07/28/2023          30       $46.14       $5.13
    104272-02                102717987001 178523742  LEWIS            TINA       18   586338014983073401   07/28/2023          30      $127.87      $14.10
    104272-02                102717987001 178523742  LEWIS            TINA       18   160316194751273401   07/28/2023          30      $111.37      $12.86
    104272-02                102717987001 178523742  LEWIS            TINA       18   987741284980273401   07/28/2023          30      $217.84       $8.54
    104272-02                102717987001 178523742  LEWIS            TINA       18   764751234393073401   07/28/2023          30      $396.26     $236.35
    104272-02                102717987001 178523742  LEWIS            TINA       18   341874134293073401   07/28/2023          30      $170.53      $21.74
    104272-02                102717987001 178523742  LEWIS            TINA       18   547779645093073401   07/28/2023          30      $864.34     $572.10
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   22813829784          07/18/2023           1       $40.00      $33.32
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   22813829784          07/18/2023           1       $15.00      $11.87
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   22813829784          07/18/2023           1       $25.00      $24.58
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   443132970543863401   07/28/2023          30      $105.06       $5.06

                                                                                                                                              PAGE:29 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   142072920443863401   07/28/2023          30      $254.27      $45.61
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   22813829784          07/18/2023           1       $30.00      $22.41
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   871082870243863401   07/28/2023          30      $123.65      $35.73
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813845232          07/20/2023           5      $412.50     $155.40
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22814070513          07/20/2023           1      $209.00     $107.83
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22814070514          07/21/2023           1      $230.00     $116.03
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22814064723          07/24/2023           5      $412.50     $155.40
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22814261515          07/11/2023           1      $530.00      $75.93
    104272-02                114821237001 178664294  RAKAR            DARCY      18   686232441437892401   07/24/2023          30      $227.27       $0.00
    104272-02                114821237001 178664294  RAKAR            DARCY      18   221937519437892401   07/24/2023          30       $82.42       $0.00
    104272-02                114821237001 178664294  RAKAR            THEODORE   01   832636204698153401   07/27/2023          30       $48.40       $0.00
    104272-02                114821237001 178664294  RAKAR            THEODORE   01   566706269988992401   07/24/2023          30       $36.21       $0.00
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613912523          07/18/2023           1      $424.00      $54.21
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613912523          07/18/2023           1       $65.00      $39.89
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613912523          07/18/2023           1       $65.00      $49.85
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613912523          07/18/2023           1       $97.00      $68.74
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613912523          07/18/2023           1       $92.00      $86.25
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   22613872488          07/18/2023           1       $10.00       $3.42
    104272-02                118208355001 179643695  NILESKI          CAMDEN     19   22614285402          07/27/2023           1      $120.00     $110.01
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22313853724          07/20/2023           2      $160.00       $8.26
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22313853724          07/20/2023           1       $56.00      $24.58
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22314108337          07/24/2023           1       $56.00      $24.58
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   69494723841023401    07/25/2023          30      $112.30      $20.62
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22314108337          07/24/2023           1       $56.00      $28.53
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22314108337          07/24/2023           2      $160.00      $45.20
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22313853724          07/20/2023           1      $124.00      $83.63
    104272-02                118477767001 180707184  TEMPLETON        NICOLE     18   22313853724          07/20/2023           1       $56.00      $28.53
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   417707413933863401   07/28/2023          30       $25.72       $8.88
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   224177577243863401   07/28/2023          30      $121.59      $13.12
    104272-02                102971874001 181603269  STEPHAN          NICOLE     01   22314211927          01/06/2023           1      $400.00     $236.00
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   494924521143863401   07/28/2023          28    $1,952.57   $1,299.85
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   378682504657173401   07/28/2023          30      $114.39      $25.06

                                                                                                                                              PAGE:30 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213858001          05/17/2023           1       $76.00      $25.92
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   787592121026863401   07/28/2023          25      $266.47      $17.71
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213858001          05/17/2023           1       $37.00      $13.52
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213817767          07/06/2023           1       $90.00      $89.99
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213858001          05/17/2023           1       $92.00      $84.06
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213858001          05/17/2023           1       $65.00      $38.88
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   584718284126863401   07/28/2023           7       $36.03      $11.51
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213858001          05/17/2023           1      $424.00      $52.84
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   955161264436863401   07/28/2023          30      $112.30      $20.62
    104272-02                103127176001 183587982  CAMERON          JOSEPH     18   369692661596053401   07/27/2023          30       $14.03       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   610977083575992401   07/24/2023          30       $13.79       $0.00
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22713856181          07/17/2023           1       $24.00      $12.84
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22714040536          03/10/2023           1      $150.00      $85.70
    104272-02                120874357001 185584906  KEMOCK           THERESA    18   244385031669203401   07/24/2023          28    $1,357.49     $901.89
    104272-02                120874357001 185584906  KEMOCK           THERESA    18   399324043569203401   07/24/2023          30       $36.82       $5.62
    104272-02                120874357001 185584906  KEMOCK           THERESA    18   129436340185023401   07/25/2023          30      $332.01       $7.20
    104272-02                103291874001 185601588  CRISTE           THOMAS     01   22813854834          07/21/2023           1       $40.00       $0.00
    104272-02                103291874001 185601588  CRISTE           THOMAS     01   22813854834          07/21/2023           1      $110.00       $0.00
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22813861734          07/18/2023           1      $125.00      $72.85
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   38686374384033401    07/26/2023          30      $173.02       $8.54
    104272-02                115775315001 187704817  SIPE             SCOTT      01   69664023081382401    07/23/2023          25       $78.16      $57.25
    104272-02                115775315001 187704817  SIPE             SCOTT      01   22814070261          07/17/2023           1      $209.00     $120.81
    104272-02                103551054001 188665731  KIM              MADISON    19   569916489709633401   07/26/2023          91      $332.25      $24.01
    104272-02                103551054001 188665731  KIM              AMY        18   22614197752          02/06/2023           1       $48.00      $57.40
    104272-02                103551054001 188665731  KIM              MADISON    19   22614240844          07/03/2023           1      $180.00      $75.13
    104272-02                103551054001 188665731  KIM              MADISON    19   22614240844          07/03/2023           1      $150.00      $85.70
    104272-02                103551054001 188665731  KIM              AMY        18   22614197752          02/06/2023           1      $497.00     $220.83
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22114178984          07/26/2023           1       $40.00      $12.84
    104272-02                103553425001 188685513  KIRSCH           MELISSA    18   22114175601          07/03/2023           1      $290.00     $157.86
    104272-02                103625291001 189584046  WESTRICK         STEPHEN    18   620004013226353401   07/27/2023          30      $584.61      $30.89
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22032675851          07/24/2023           1       $25.00      $24.58
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22032842384          07/25/2023           1       $25.00       $4.95

                                                                                                                                              PAGE:31 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22032675851          07/24/2023           1       $20.00      $12.15
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   12116499627103401    07/24/2023          28    $1,618.82   $1,299.85
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22032842384          07/25/2023           1      $135.00     $130.20
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22032675851          07/24/2023           1       $15.00      $11.87
    104272-02                111045735001 189641841  MILLER           JOHN       01   22032900301          07/05/2023           1      $150.00      $85.70
    104272-02                111045735001 189641841  MILLER           JOHN       01   22032900301          07/05/2023           1      $170.00      $50.08
    104272-02                111045735001 189641841  MILLER           MYAH       19   22032842386          07/25/2023           1       $25.00       $4.95
    104272-02                111045735001 189641841  MILLER           MYAH       19   22032842386          07/25/2023           1      $135.00     $130.20
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22032675851          07/24/2023           1       $40.00      $33.32
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22614239558          07/24/2023           2       $58.00      $56.48
    104272-02                103643051001 189746790  VANFOSSEN        ALESHA     18   22514020713          06/26/2023           1      $150.00      $85.70
    104272-02                103643051001 189746790  VANFOSSEN        ALESHA     18   833532164597282401   07/23/2023          30       $36.21       $8.23
    104272-02                103699741001 190489435  SMITH            DORIS      18   22413833772          07/14/2023           1      $129.00       $0.00
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313788901          05/10/2023           1       $20.00      $20.00
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313788901          05/14/2023           1       $20.00      $20.00
    104272-02                103713375001 190569811  SCHWEITZER       AMELIA     19   22313920471          07/19/2023           1      $158.00     $110.01
    104272-02                103713375001 190569811  SCHWEITZER       EMMA       19   22313794067          07/10/2023           1      $129.00     $126.85
    104272-02                103713375001 190569811  SCHWEITZER       DANIEL     19   611354473684813401   07/25/2023           2      $743.99     $399.25
    104272-02                103717291001 190600652  KUPCHELLA        KATHY      18   903798814268763401   07/28/2023           6       $42.80      $11.74
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   158344992559470401   07/11/2023          90       $97.20       $0.00
    104272-02                103717291001 190600652  KUPCHELLA        KATHY      18   493609315815573401   07/28/2023          90      $525.33     $279.74
    104272-02                115278421001 190668800  DUGAN            JOLENE     18   97521028913583401    07/29/2023          30      $170.68       $0.00
    104272-02                115278421001 190668800  DUGAN            REX        19   501237539946173401   07/28/2023          15       $27.25       $0.00
    104272-02                115278421001 190668800  DUGAN            BRADLEY    01   22414008214          07/13/2023           1       $31.00       $0.00
    104272-02                115278421001 190668800  DUGAN            BRADLEY    01   22414008214          07/13/2023           1      $236.00       $0.00
    104272-02                115278421001 190668800  DUGAN            BRADLEY    01   22414008214          07/13/2023           1      $135.00       $0.00
    104272-02                103812819001 191649655  PROKOP           DAVID      01   377037266857373401   07/28/2023          90      $171.20      $16.21
    104272-02                103812819001 191649655  PROKOP           ALEC       19   290338884544453401   07/27/2023          30      $541.81     $356.40
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22614269457          07/25/2023           1       $12.00       $4.00
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   465785771730203401   07/24/2023          30      $172.71       $9.88
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   807146439598633401   07/26/2023          30      $522.37      $30.41
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   375208794185713401   07/25/2023           7       $21.61       $7.31

                                                                                                                                              PAGE:32 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22614269457          07/25/2023           1      $200.00     $100.00
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   22713998915          07/18/2023           1      $155.00      $85.70
    104272-02                103815975001 191683834  RHODES           LORI       18   22314186982          07/25/2023           1      $209.00       $0.00
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   22214277053          07/25/2023           2       $94.00      $45.20
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   22214277053          07/25/2023           1       $60.00      $60.00
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814070063          07/24/2023           1      $142.00      $76.50
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814064577          07/24/2023           1       $33.00      $22.60
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           1      $210.00     $135.36
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814064577          07/24/2023           1      $123.00      $83.63
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814173705          07/26/2023           1      $328.02      $94.08
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814064577          07/24/2023           1       $20.00      $12.84
    104272-02                103960961001 193522698  PAGANO           KAREN      18   184834003814333401   07/26/2023          30      $229.40      $43.67
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           1       $60.52      $25.42
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           1       $52.50      $14.00
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           3      $225.00     $150.21
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           1       $64.17      $47.93
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   914076870331503401   07/24/2023          30        $4.00       $4.00
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22814264561          07/25/2023           6       $31.80      $19.80
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814064577          07/24/2023           1       $18.00      $11.87
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22814173705          07/26/2023           1      $485.64     $134.19
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22514009759          07/19/2023           1      $273.00      $64.45
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22514009759          07/19/2023           1       $31.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $96.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $87.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1      $128.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $32.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $23.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1      $119.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1      $188.00      $34.09
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $98.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $61.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1      $102.00       $0.00

                                                                                                                                              PAGE:33 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513955686          07/20/2023           1       $96.00     $269.90
    104272-02                122025702001 194581386  TAYLOR           JAMES      01   733946980322233401   07/26/2023          30      $122.42       $5.48
    104272-02                122025702001 194581386  TAYLOR           JAMES      01   449988644322233401   07/26/2023          30       $64.60       $0.00
    104272-02                122025702001 194581386  TAYLOR           JAMES      01   820754514322233401   07/26/2023          30       $72.19       $0.00
    104272-02                122025702001 194581386  TAYLOR           JAMES      01   459958764322233401   07/26/2023          30      $104.95       $0.00
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   896088564343583401   07/29/2023          30      $170.68       $0.00
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   446544584343583401   07/29/2023          30      $146.30       $0.00
    104272-02                119714565001 194708189  HRITZ            JESSICA    01   287860051565203401   07/24/2023          14       $23.96       $0.00
    104272-02                128444029001 194743165  CRUSE            EMILY      18   22714040495          06/26/2023           1      $130.00       $0.00
    104272-02                128444029001 194743165  CRUSE            EMILY      18   22714040495          06/26/2023           1       $50.00      $20.20
    104272-02                128444029001 194743165  CRUSE            EMILY      18   22714040495          06/26/2023           1       $80.00      $33.14
    104272-02                104227685001 196581553  BEYER            JOSEPH     01   376777043679623401   07/26/2023          90      $413.50     $296.01
    104272-02                126459656001 196721440  SCOTT            JESSICA    18   22814224888          07/06/2023           1      $200.00       $0.00
    104272-02                135291530001 196767240  FARABAUGH        DOMINIC    18   114338044199382401   07/23/2023          30      $845.36      $59.29
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22314159003          07/08/2023           1      $225.00     $105.99
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22314159003          07/08/2023           1       $75.00      $16.50
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22314180666          07/26/2023           5      $412.50     $155.40
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   454387826146892401   07/24/2023          14       $18.99       $7.63
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22314159003          07/08/2023           1       $75.00      $16.50
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22313824714          07/20/2023           2      $165.00      $62.16
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22313824714          07/20/2023           1      $270.00      $84.19
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513825612          07/17/2023           1      $715.00      $38.56
    104272-02                104561618001 200626571  MYERS            JULIA      19   22514201435          01/11/2023           1       $20.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   183342471685892401   07/24/2023          30       $46.14       $0.00
    104272-02                104561618001 200626571  MYERS            JULIA      19   916424053947892401   07/24/2023          30      $391.34       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513825612          07/17/2023           1      $358.00      $30.99
    104272-02                115775312001 201600981  SEDOR            DENISE     18   722766540272533401   07/25/2023         (30)   ($299.86)       $0.00
    104272-02                115775312001 201600981  SEDOR            DENISE     18   736705081730713401   07/25/2023          30      $299.86       $0.00
    104272-02                115775312001 201600981  SEDOR            DENISE     18   821657667272533401   07/25/2023          30      $238.22       $0.00
    104272-02                121180930001 201720071  FINI-DOMONKOS    CHRISTIN   01   22714039047          07/12/2023           1      $175.00     $110.01
    104272-02                121180930001 201720071  DOMONKOS         DANE       18   22714156425          07/25/2023           1       $95.00      $85.70
    104272-02                121180930001 201720071  DOMONKOS         DANE       18   22714156425          07/25/2023           1       $10.00      $10.00

                                                                                                                                              PAGE:34 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   22032650363          07/08/2023           1      $127.00       $0.00
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   22032650363          07/08/2023           1      $172.00       $0.00
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   22032650363          07/08/2023           1      $127.00       $0.00
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   22032899921          07/08/2023           1      $200.00       $0.00
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   22032899921          07/08/2023           1       $20.00       $0.00
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22414179226          07/24/2023           2      $172.00      $45.20
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413979101          07/21/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413979101          07/21/2023           2      $172.00      $45.20
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413979101          07/21/2023           1       $97.00      $28.53
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413854806          07/19/2023           1       $86.00      $22.60
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22414179226          07/24/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413854806          07/19/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22414179226          07/24/2023           1       $97.00      $28.53
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413854806          07/19/2023           1       $97.00      $28.53
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1      $521.00     $363.52
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1      $126.00      $52.98
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1      $163.00      $43.43
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   22814040453          06/27/2023           1      $150.00      $85.70
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1      $126.00      $52.98
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           2        $8.81       $0.00
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   197675851878872401   07/23/2023          90    $1,972.84   $1,459.75
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1       $65.00      $39.89
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   22814246655          04/12/2023           1      $312.00      $44.85
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813896140          07/17/2023           1       $14.00       $0.00
    104272-02                104811837001 203624160  DORSCH           MARIBETH   18   22613878469          07/19/2023           1       $95.00      $72.85
    104272-02                104811837001 203624160  DORSCH           ALEXANDE   19   787182644266433401   07/26/2023          10       $18.40      $11.77
    104272-02                104811837001 203624160  DORSCH           MARIBETH   18   22614056352          07/20/2023           1      $163.00     $102.70
    104272-02                104811837001 203624160  DORSCH           ALEXANDE   19   472740071437433401   07/26/2023           7      $270.02     $138.92
    104272-02                104811837001 203624160  DORSCH           ALEXANDE   19   22613844634          07/20/2023           1      $195.00      $74.94
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1       $40.00       $2.99
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1      $385.00     $292.72
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1       $35.00      $16.70

                                                                                                                                              PAGE:35 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1       $40.00       $4.95
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1      $185.00     $130.20
    104272-02                104816750001 203661643  RODKEY           JULIE      19   22514206600          07/26/2023           1       $40.00       $4.95
    104272-02                104816750001 203661643  RODKEY           JACOB      19   22514206590          07/26/2023           1       $40.00      $21.21
    104272-02                104816750001 203661643  RODKEY           JULIE      19   22514206600          07/26/2023           1      $185.00     $130.20
    104272-02                104816750001 203661643  RODKEY           JULIE      19   22514206600          07/26/2023           1       $35.00      $16.70
    104272-02                104816750001 203661643  RODKEY           JULIE      19   22514206600          07/26/2023           1       $40.00       $2.99
    104272-02                104821551001 203720987  YESENOSKY        BRADY      19   22032865880          07/24/2023           1       $37.00      $18.36
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927708          07/19/2023           1      $175.00      $38.74
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927709          07/21/2023           1      $102.00      $53.70
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927708          07/19/2023           1      $102.00      $53.70
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927709          07/21/2023           1      $175.00      $38.74
    104272-02                104821606001 203721732  SHANER           LOGAN      19   176921508962053401   07/27/2023           7       $71.05      $13.59
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927709          07/21/2023           1       $23.00       $0.00
    104272-02                104821606001 203721732  SHANER           JESSICA    18   22113927708          07/19/2023           1       $23.00       $0.00
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213781918          07/07/2023           1      $125.00      $80.66
    104272-02                104900285001 204643617  PABLIC KUBAT     BROOKE     19   837672964282613401   07/25/2023          28       $48.67      $14.86
    104272-02                104900285001 204643617  PABLIC KUBAT     BROOKE     19   117866814766833401   07/26/2023          30      $124.06       $5.06
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   796776920652683401   07/29/2023          10      $154.28       $9.73
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22414202210          07/24/2023           1       $50.00      $33.32
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22414202210          07/24/2023           1       $40.00      $10.45
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   930201798583283401   07/29/2023          30      $316.03      $15.70
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22414202210          07/24/2023           1       $40.00      $11.87
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22414202210          07/24/2023           1       $60.00      $22.41
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514084996          07/18/2023           1       $89.00      $31.52
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514129926          07/21/2023           1    $2,569.00   $1,838.78
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514267095          07/20/2023           1       $79.00      $32.87
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514267095          07/20/2023           1       $75.00      $26.36
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513902196          07/14/2023           1       $56.00      $22.87
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514084996          07/18/2023           1       $75.00      $26.36
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514084996          07/18/2023           1      $101.00      $42.95
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514084996          07/18/2023           1       $79.00      $32.87

                                                                                                                                              PAGE:36 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514267095          07/20/2023           1       $89.00      $31.52
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513902196          07/14/2023           1       $89.00      $40.77
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513902196          07/14/2023           1       $89.00      $31.76
    104272-02                105057437001 206567193  GILKEY           KEITH      18   961532864665182401   07/23/2023          90      $171.20      $16.21
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514267095          07/20/2023           1       $56.00      $22.62
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514084996          07/18/2023           1       $56.00      $22.62
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513902196          07/14/2023           1       $79.00      $33.12
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22514267095          07/20/2023           1      $101.00      $42.95
    104272-02                126292746001 207709667  JOHNSON          ASHLEY     18   22314182391          07/24/2023           1       $45.00      $23.27
    104272-02                126292746001 207709667  JOHNSON          ASHLEY     18   22314202958          07/27/2023           1      $225.00     $178.53
    104272-02                126292746001 207709667  JOHNSON          ASHLEY     18   22314182391          07/24/2023           1       $30.00      $24.58
    104272-02                110609957001 210620704  STRUNK           WENDY      18   22213807036          07/15/2023           1      $715.00      $38.56
    104272-02                110609957001 210620704  STRUNK           WENDY      18   22213858040          07/15/2023           1       $48.00      $58.59
    104272-02                110609957001 210620704  STRUNK           JEREMIAH   19   269138334652533401   07/26/2023          30      $148.45       $0.00
    104272-02                110609957001 210620704  STRUNK           JEREMIAH   19   41856469852533401    07/26/2023          30      $109.78       $0.00
    104272-02                110609957001 210620704  STRUNK           WENDY      18   22213858040          07/15/2023           1      $497.00     $225.44
    104272-02                110609957001 210620704  STRUNK           WENDY      18   22213807036          07/15/2023           1      $358.00      $30.99
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   895237963531863401   07/28/2023          30      $195.00       $5.45
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613912552          07/18/2023           3      $173.00       $0.00
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613999763          07/18/2023           1      $226.00      $49.14
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613871047          07/01/2022          98       $37.98      $25.48
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613912552          07/18/2023           1    $2,187.00     $867.19
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613871051          12/16/2022          98       $37.98      $25.48
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1       $73.00      $11.92
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $455.00     $406.89
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $237.00      $28.30
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023         100      $100.00      $62.03
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $214.00     $189.96
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213781711          07/09/2023           1      $330.00     $141.73
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $118.00       $6.98
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213807031          07/12/2023           1      $611.00      $82.22
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $128.00     $141.96

                                                                                                                                              PAGE:37 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1      $118.00       $6.98
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           4      $230.00      $96.76
    104272-02                126653510001 210721634  BOLAND           BLAKLEY    19   22213926543          07/19/2023           1      $260.00      $32.44
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213290963          07/09/2023           1    $1,815.00     $592.20
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22313977037          06/26/2023           1      $200.00     $120.81
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22313977037          06/26/2023           1      $110.00      $47.13
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22314158983          07/07/2023           1      $150.00      $85.70
    104272-02                111997101001 211626742  DUNCAN           ELI        19   22314158982          07/07/2023           1      $150.00      $85.70
    104272-02                128385523001 305155123  LOHR             EMMA       19   22113995204          07/24/2023           1      $185.00     $112.39
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           1       $40.27      $76.35
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           2      $182.00     $345.07
    104272-02                128385523001 305155123  LOHR             EMMA       19   22113995203          07/22/2023           1      $170.00     $122.84
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22114220951          07/18/2023           1      $434.00     $248.43
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22114022609          07/21/2023           1      $589.00      $89.55
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22113935075          07/21/2023           1    $4,199.00   $2,684.25
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           1      $137.40     $260.51
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           1       $67.00     $127.06
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           1      $812.00   $1,539.56
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22114220951          07/18/2023           1      $312.00       $0.00
    104272-02                128385523001 305155123  LOHR             EMMA       19   22114220938          07/21/2023           1       $46.00      $87.21
    104272-02                107536593001 391923055  SHAFFER          NICHOLAS   18   22313683256          07/11/2023           1      $118.50      $74.94
    104272-02                107536593001 391923055  SHAFFER          LYDIA      19   58737197717173401    07/28/2023          30      $121.24       $6.66
    104272-02                107536593001 391923055  SHAFFER          THERESE    01   22313681805          07/11/2023           1      $118.50      $74.94
    104272-02                107536593001 391923055  SHAFFER          IAN        19   22313979785          07/24/2023           1       $70.00      $26.58
    104272-02                107536593001 391923055  SHAFFER          LYDIA      19   22313979782          07/24/2023           1      $420.00     $173.92
  104272-02 Total                                                                                                                   $96,084.73  $42,574.63
  104272-09
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   491827333527763401   07/28/2023          30       $82.42       $5.84
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   72855811847582401    07/23/2023          28      $205.26     $165.47
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714172591          07/24/2023          10       $43.20       $9.10
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714029603          07/07/2023           1      $236.00      $69.76
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713962016          07/20/2023           4    $1,144.00     $972.00

                                                                                                                                              PAGE:38 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713897110          07/18/2023          69      $122.69       $0.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714029603          07/07/2023           1      $217.00      $67.68
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714029603          07/07/2023           1       $93.25      $22.73
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714172591          07/24/2023           3      $858.00     $729.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713962016          07/20/2023           4      $256.80      $30.28
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713897110          07/18/2023          30       $57.75       $0.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714172591          07/24/2023           3      $192.60      $22.71
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714029603          07/07/2023           1      $265.00      $70.27
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714029603          07/07/2023           1      $129.00      $31.97
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713962016          07/20/2023          10       $43.20       $9.10
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22714172591          07/24/2023          14      $268.43     $154.14
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713962016          07/20/2023          18      $357.91     $198.18
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713897110          07/18/2023           1    $6,010.00     $673.14
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   22313977111          06/27/2023           1      $200.00     $120.81
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   22313977111          06/27/2023           1       $16.00       $2.50
    104272-09                112895895001 171602746  MESORAS          MACY       19   22314162806          07/26/2023           1      $160.00     $126.85
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   22313977111          06/27/2023           1       $50.00       $8.00
    104272-09                112895895001 171602746  MESORAS          BELLA      19   22314071796          07/25/2023           1      $185.00     $130.20
    104272-09                112895895001 171602746  MESORAS          BELLA      19   22314071796          07/25/2023           1       $40.00       $2.99
    104272-09                112895895001 171602746  MESORAS          BELLA      19   22314071796          07/25/2023           1       $40.00       $4.95
    104272-09                112895895001 171602746  MESORAS          BELLA      19   22314071796          07/25/2023           1       $35.00      $16.70
    104272-09                118503729001 181720719  SANTINI          EMILY      01   589997717950603401   07/11/2023         (30) ($1,042.69)   ($836.71)
    104272-09                113645111001 199688428  STRITTMATTER     HADYN      19   22514116424          07/25/2023           1       $40.00       $4.95
    104272-09                113645111001 199688428  STRITTMATTER     ALISHA     01   22513981836          07/21/2023           1      $215.00     $105.99
    104272-09                113645111001 199688428  STRITTMATTER     HADYN      19   22514116424          07/25/2023           1      $185.00     $130.20
    104272-09                113645111001 199688428  STRITTMATTER     HADYN      19   22514116424          07/25/2023           1       $40.00       $2.99
    104272-09                113645111001 199688428  STRITTMATTER     HADYN      19   22514116424          07/25/2023           1       $35.00      $16.70
    104272-09                105389627001 210488446  MCGILL           LAURA      18   293604744747553401   07/27/2023          28       $69.09       $3.21
  104272-09 Total                                                                                                                   $10,849.91   $3,071.70
  104272-12
    104272-12                102796755001 179543072  MINOR            KAREN      18   22613861562          06/05/2023           1    $1,520.00       $0.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513795179          07/17/2023           1      $172.00       $0.00

                                                                                                                                              PAGE:39 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513795179          07/17/2023           1       $26.00       $0.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513936217          07/20/2023           1      $190.00     $100.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513795179          07/17/2023           1      $311.00       $0.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513795179          07/17/2023           1      $594.00       $0.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513795179          07/17/2023           1      $251.00       $0.00
    104272-12                135039874001 183502743  MAZZARELLA       TAYLOR     19   348547886203292401   07/24/2023          84      $114.94      $33.40
    104272-12                135039874001 183502743  MAZZARELLA       MARY       18   22414255322          07/25/2023           1      $600.00       $0.00
    104272-12                104623467001 201509415  PERSIO           MARIA      18   491164734317282401   07/23/2023          28        $4.95       $2.39
  104272-12 Total                                                                                                                    $3,783.89     $135.79
  104272-19
    104272-19                104483547001 199688014  STRITTMATTER     JACE       19   493471404956053401   07/27/2023          10       $19.12       $4.42
  104272-19 Total                                                                                                                       $19.12       $4.42
  104272- Total                                                                                                                    $110,737.65  $45,786.54
HDHP PPO Total                                                                                                                     $198,521.30  $81,978.08
                                                                                                                                                            
Major Medical
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   38174725301          06/12/2023           1        $6.00       $4.80
  053264-01 Total                                                                                                                        $6.00       $4.80
  053264- Total                                                                                                                          $6.00       $4.80
Major Medical Total                                                                                                                      $6.00       $4.80
                                                                                                                                                            
PPO
  014267-01
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713959212          07/14/2023           1      $238.00      $95.51
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1       $88.50      $17.05
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1      $204.00      $57.79
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713820370          07/14/2023           1       $44.00      $15.41
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1       $91.50      $24.86
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1       $87.00      $57.47
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1    $1,530.00     $525.52
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713784778          12/19/2022           1      $800.00     $484.28

                                                                                                                                              PAGE:40 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713959211          07/14/2023           1       $50.00      $12.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1    $2,569.00   $1,557.25
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22714130427          07/14/2023           1      $285.00     $222.35
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1      $261.00      $34.98
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1      $135.00      $37.33
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713815488          07/14/2023           1      $236.00      $69.76
    014267-01                101612583001 164685618  DOUGLAS          LAUREN     18   22032739518          07/21/2023           1      $574.00      $50.81
    014267-01                101612583001 164685618  DOUGLAS          LAUREN     18   22032947522          07/21/2023           1       $48.00      $58.59
    014267-01                101612583001 164685618  DOUGLAS          LAUREN     18   22032739518          07/21/2023           1      $545.00      $50.81
    014267-01                101612583001 164685618  DOUGLAS          LAUREN     18   22032947522          07/21/2023           1      $497.00     $271.83
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   22113927712          07/15/2023           1      $357.00     $201.96
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   22113796860          07/15/2023           1      $150.00       $9.27
    014267-01                104231917001 196603987  HUTSKY           XAVIER     19   22113688312          12/10/2022           1       $60.00       $8.73
    014267-01                105143186001 207564217  BAUM             SUSAN      18   22212980920          06/20/2023           1    $1,600.00     $760.66
    014267-01                105143186001 207564217  BAUM             SUSAN      18   22212980920          06/20/2023           1    $1,600.00     $380.34
  014267-01 Total                                                                                                                   $12,050.00   $5,004.56
  014267-03
    014267-03                101220663001 159625419  ECKENRODE        PAUL       18   22314066673          07/21/2023           1      $220.00      $89.89
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113910889          07/19/2023           1      $346.00     $129.19
    014267-03                101369778001 161607101  LACUE            ERIN       18   22614220592          07/24/2023         200    $1,270.54   $1,247.06
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   22513825502          07/17/2023           1    $3,798.00   $1,448.26
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   22513825502          07/17/2023           8    $7,600.00       $0.00
    014267-03                101593218001 164562405  HOOVER           BRAD       01   22613925425          07/10/2023           1      $220.00       $0.00
    014267-03                101760095001 166629321  BLAKE            JODY       01   22214278547          07/26/2023           1      $190.00     $100.00
    014267-03                101760095001 166629321  BLAKE            JODY       01   22214182797          07/24/2023           1      $220.00      $89.89
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213814525          07/17/2023           1      $283.00     $140.43
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213807035          07/17/2023           1      $715.00      $38.56
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213807035          07/17/2023           1      $358.00      $30.99
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213814524          07/17/2023           1      $142.00       $0.00
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   22113911531          07/19/2023           1      $220.00      $89.89
    014267-03                102137743001 171520828  KOCHINSKY        DARLA      18   22113927528          07/11/2023           1      $378.00     $257.88
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614262910          07/26/2023           2      $160.00       $0.00

                                                                                                                                              PAGE:41 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22614097463          07/24/2023           1       $75.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614097464          07/24/2023           2      $160.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22614262909          07/26/2023           1       $75.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22614097463          07/24/2023           1       $84.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ZACHARY    19   22614154519          07/25/2023           1      $109.30      $23.48
    014267-03                102151761001 171602272  MISLEVY          ZACHARY    19   22614154519          07/25/2023           1      $218.68       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614097464          07/24/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614281149          07/25/2023           1       $40.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614097464          07/24/2023           2      $168.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22614262909          07/26/2023           1       $84.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614262910          07/26/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22614262910          07/26/2023           1       $50.00       $0.00
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   22514045168          07/18/2023           1      $119.53      $36.28
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   22514045168          07/18/2023           1       $70.87      $24.46
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   22514045168          07/18/2023           1      $130.87      $33.50
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613903205          07/12/2023           1      $570.00       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22614333050          07/17/2023           1      $114.23      $54.97
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22614015671          06/23/2023           1      $155.00      $23.40
    014267-03                102658581001 177683663  LITTLE           JILL       18   22032682456          06/27/2023           1       $60.00      $50.51
    014267-03                115784376001 178669991  PARONISH         NOAH       01   22614086991          02/05/2023           1      $220.82      $97.94
    014267-03                115784376001 178669991  PARONISH         NOAH       01   22614086990          02/03/2023           1      $220.82      $97.94
    014267-03                115784376001 178669991  PARONISH         NOAH       01   22614086989          02/02/2023           1      $149.34      $66.37
    014267-03                102813097001 179642584  MOREALLI         KIRSTEN    19   22413798208          07/18/2023           1      $222.00      $85.78
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22314149914          07/21/2023           1       $31.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22314159438          07/01/2023           1       $16.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22314159438          07/01/2023           1       $50.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22314159438          07/01/2023           1      $200.00     $100.81
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22314149914          07/21/2023           1      $164.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513963078          07/21/2023           1       $49.00      $21.21
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513963078          07/21/2023           1      $246.00     $124.83
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1      $104.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1      $245.00       $0.00

                                                                                                                                              PAGE:42 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1      $102.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1      $107.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1       $65.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513963078          07/21/2023           1      $120.00      $83.67
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1       $53.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1       $80.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1       $67.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513955684          07/20/2023           1       $23.00       $0.00
    014267-03                111759150001 183628110  BENDER           DANA       18   22314149894          07/18/2023           1      $866.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886490          07/11/2023           1       $67.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886490          07/11/2023           1       $96.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22412507242          05/26/2023           1       $84.00       $5.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886490          07/11/2023           1      $102.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22412507242          05/26/2023           1      $200.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886490          07/11/2023           1       $23.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886484          06/29/2023           1       $23.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886484          06/29/2023           1      $172.00       $4.30
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22413886490          07/11/2023           1       $86.00       $0.00
    014267-03                103305848001 185705093  LANE             APRIL      18   22514197922          07/25/2023           1      $192.00     $110.50
    014267-03                103305848001 185705093  LANE             APRIL      18   22514197922          07/25/2023           1       $36.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22214117764          07/16/2023           4      $756.00     $354.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22214117764          07/16/2023           4       $70.92       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22214003688          07/21/2023           1       $76.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22214205911          07/12/2023           1      $300.00     $117.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22214003688          07/21/2023           1      $106.00       $0.00
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           1      $350.00     $292.66
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           1      $185.00     $112.39
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           5      $200.00      $80.07
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           1      $250.00     $202.14
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           1      $195.00     $125.27
    014267-03                128323370001 189744510  HITE             ZOEY       19   22214096845          07/25/2023           3      $120.00      $63.63
    014267-03                128323370001 189744510  TOTH             BRIANNA    18   22214091599          07/20/2023           1      $145.00      $54.97

                                                                                                                                              PAGE:43 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513867058          06/23/2023           1      $852.50     $162.25
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513867056          06/23/2023           1      $841.50     $162.25
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   22314161172          07/25/2023           1      $190.00     $100.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813815227          07/17/2023           1      $190.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514152457          07/26/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514061593          07/25/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514239705          07/27/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813815227          07/17/2023           1      $184.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514239705          07/27/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514152457          07/26/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514239705          07/27/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813815227          07/17/2023           1      $135.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514061593          07/25/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813815227          07/17/2023           1       $31.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514061593          07/25/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22514152457          07/26/2023           1       $50.00       $3.32
    014267-03                103818021001 191709419  OWENS            ALLISON    18   22614123502          06/29/2023           2      $201.74     $190.00
    014267-03                103904590001 192761255  SHERRY           EMMA       19   22414053487          07/25/2023           1      $140.00     $113.67
    014267-03                103904590001 192761255  SHERRY           EMMA       19   22414053487          07/25/2023           1       $25.00      $10.43
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813886930          07/13/2023           1    $1,116.90     $430.70
    014267-03                115783835001 194687195  BENDER           SHANON     18   22513963030          07/20/2023           1      $124.00      $85.54
    014267-03                115783835001 194687195  BENDER           SHANON     18   22514069249          07/20/2023           1      $260.00     $111.61
    014267-03                104155108001 195660239  LINK             LORI       18   22714225697          07/25/2023           1      $190.00     $100.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032490056          07/13/2023           1      $394.00       $0.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032745899          05/29/2023           1      $362.76     $184.60
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032494954          07/12/2023           1      $118.00       $0.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032890919          07/20/2023           1      $394.00       $0.00
    014267-03                117356283001 199567270  CENCE            JULIE      18   22032562141          07/14/2023           1      $119.53      $36.28
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032638452          07/18/2023           1      $228.00       $0.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032638452          07/18/2023           1       $42.00       $0.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032638452          07/18/2023           1       $31.00       $0.00
    014267-03                114913504001 199665874  PETRE            RUBY       19   22114152641          06/23/2023           1      $315.00     $112.90

                                                                                                                                              PAGE:44 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                119613821001 199689276  ZADZILKO         ANDREW     01   22514182042          07/19/2023           1       $47.00       $3.32
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22513876051          07/17/2023           1      $691.00       $0.00
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22713850667          07/20/2023           1      $120.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $22.69       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023          82      $228.18       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $91.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1      $102.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1      $104.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $67.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1    $1,701.00   $1,174.07
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $83.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   22614247175          07/26/2023           1       $25.00       $4.95
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   22614247175          07/26/2023           1      $135.00     $130.20
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $23.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1    $3,731.00     $856.40
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613912539          07/16/2023           1       $56.00       $0.00
    014267-03                104567865001 200681648  MCCULLOUGH       LANDRY     19   22614247175          07/26/2023           1       $25.00       $4.95
    014267-03                110124351001 202707741  MANIFEST         ALESANDR   19   22032622464          07/06/2023           1      $350.00       $0.00
    014267-03                105151459001 207608668  LEAMER           MARY       18   22414109604          07/20/2023          20      $450.00       $0.00
    014267-03                105154214001 207627750  KLINE            BRIAN      01   22514202191          07/25/2023           1       $25.00      $19.08
    014267-03                105154214001 207627750  KLINE            BRANDY     18   22514202709          07/03/2023           1      $200.00     $100.81
    014267-03                105154214001 207627750  KLINE            BRANDY     18   22514202709          07/03/2023           1      $150.00       $0.00
    014267-03                105154214001 207627750  KLINE            BRANDY     18   22514202709          07/03/2023           1       $47.00       $0.00
    014267-03                105154214001 207627750  KLINE            BRIAN      01   22514202191          07/25/2023           1      $135.00      $69.99
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22113916423          07/06/2023           1       $88.50      $17.05
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22113916423          07/06/2023           1      $135.00      $37.33
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032650359          07/21/2023           1       $23.00       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032954244          01/06/2023           1      $560.00     $371.70
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032764841          07/21/2023           1    $3,409.00   $1,098.29
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032650359          07/21/2023           1      $127.00       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032650359          07/21/2023           1      $161.00       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032764841          07/21/2023         100      $278.27      $36.00

                                                                                                                                              PAGE:45 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032764841          07/21/2023           1    $1,673.00     $572.87
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22025018264          03/17/2023           1    $1,468.80     $283.20
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032650359          07/21/2023           1      $108.00       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032650359          07/21/2023           1       $67.00       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22314186581          07/26/2023          90    $3,452.91     $314.97
  014267-03 Total                                                                                                                   $52,687.20  $13,014.49
  014267-05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22814215567          07/20/2023           1    $1,309.00     $147.83
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813845376          07/14/2023           1      $150.00      $10.04
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22814069230          07/18/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22814215567          07/20/2023           1      $400.00      $91.17
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813896159          07/14/2023           1      $172.00     $172.00
    014267-05                135605376001 165742483  WHALEN           BRITTANY   18   22032562083          07/12/2023           1      $119.53      $36.28
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1      $104.00      $17.25
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1      $102.00      $21.78
    014267-05                101829382001 167588314  LYTLE            ELLA       19   22714132339          07/21/2023           1      $175.00      $77.69
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1       $96.00       $0.00
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1      $167.00       $0.00
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1       $91.00      $12.20
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1      $107.00      $21.03
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1       $86.00      $11.27
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1       $67.00       $0.00
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714269641          07/21/2023           1       $67.00      $20.00
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   22714173566          07/21/2023           1        $8.00       $0.00
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22514202753          07/06/2023           1      $290.00     $132.86
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22514009772          07/14/2023           1      $261.00       $0.00
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22514110759          07/14/2023           1      $145.00      $49.97
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22514202753          07/06/2023           1      $110.00       $0.00
    014267-05                102158846001 171645338  KOENIGSBERG      COLLEEN    18   22807335881          04/06/2023           1      $220.00     $101.85
    014267-05                112950694001 171683760  GONZALEZ         AMANDA     18   22113838869          07/14/2023           1      $119.53      $36.28
    014267-05                112950694001 171683760  GONZALEZ         ANTHONY    19   22113992949          06/25/2023           1       $90.00       $0.00
    014267-05                112950694001 171683760  GONZALEZ         ANTHONY    19   22114178980          07/26/2023           1      $185.00     $118.97

                                                                                                                                              PAGE:46 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                112950694001 171683760  GONZALEZ         ANTHONY    19   22113992949          06/25/2023           1      $290.00     $132.86
    014267-05                112950694001 171683760  GONZALEZ         ANTHONY    19   22114178980          07/26/2023           1       $40.00       $2.99
    014267-05                112950694001 171683760  GONZALEZ         ANTHONY    19   22114178980          07/26/2023           1       $35.00      $16.70
    014267-05                112950694001 171683760  GONZALEZ         AMANDA     18   22113838869          07/14/2023           1      $130.87      $33.50
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   22514020653          07/24/2023           1       $45.00       $8.32
    014267-05                129935534001 172742640  CAMPBELL         CAROLINE   18   22514049455          07/10/2023           1      $142.00     $100.00
    014267-05                115391991001 174547012  JACOBS           TIMOTHY    18   22313707955          07/10/2023           1       $75.00      $28.48
    014267-05                102864840001 180482050  PARONISH         AMY        01   22614021378          07/20/2023          60      $504.56     $477.28
    014267-05                102892610001 180645375  PARONISH         JACQUELI   18   22214026246          07/13/2023           1      $119.53      $36.28
    014267-05                102971934001 181603444  NELSON           JULIE      01   22032737715          07/24/2023           2        $4.00       $0.80
    014267-05                102971934001 181603444  NELSON           JULIE      01   22714274194          07/14/2023           1       $50.00       $8.32
    014267-05                102971934001 181603444  NELSON           JULIE      01   22714274194          07/14/2023           1       $30.00       $0.00
    014267-05                102971934001 181603444  NELSON           JULIE      01   22714274194          07/14/2023           2       $80.00      $46.68
    014267-05                102971934001 181603444  NELSON           JULIE      01   22032737715          07/24/2023           1       $30.00      $12.22
    014267-05                116687100001 185720983  GETZ             KATHYJO    18   22313920424          07/19/2023           1      $142.00      $64.99
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313899210          07/18/2023           1      $715.00      $38.56
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313833693          07/18/2023           1       $97.00      $68.74
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313833694          07/18/2023           1      $427.00     $427.00
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313800271          07/20/2023           1      $195.00     $101.85
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313833693          07/18/2023           1      $163.00       $0.00
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313833693          07/18/2023           1       $14.00       $0.00
    014267-05                103380060001 186626373  SCALESE          TRACY      18   22313833693          07/18/2023           1       $65.00      $49.85
    014267-05                115392593001 189764421  FOX              JENNIFER   18   22214213578          07/27/2023           1      $120.00     $110.01
    014267-05                115392593001 189764421  FOX              JENNIFER   18   22213812182          07/20/2023           1      $120.00     $110.01
    014267-05                133298619001 193702336  SMITH            BRANDON    01   22613929516          07/17/2023           1      $108.00      $60.70
    014267-05                104144215001 195582778  DUMM             CAMRYN     19   22413964052          07/24/2023           1      $150.00     $110.50
    014267-05                104144215001 195582778  DUMM             CAMRYN     19   22413964052          07/24/2023           1      $230.00      $95.81
    014267-05                104144215001 195582778  DUMM             CAMRYN     19   22413964052          07/24/2023           1       $30.00      $15.90
    014267-05                104144215001 195582778  DUMM             CAMRYN     19   22413964052          07/24/2023           1       $30.00       $4.71
    014267-05                114823092001 195700139  BORLIE           JOHN       19   22314066257          07/12/2023           1      $149.00      $46.89
    014267-05                114823092001 195700139  BORLIE           JOHN       19   22313896665          07/12/2023           1      $112.00      $41.08
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1       $67.00      $34.47

                                                                                                                                              PAGE:47 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1      $185.00     $130.20
    014267-05                104213378001 196487222  MICCO            DINA       18   22213923704          07/20/2023           1      $150.00       $0.00
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1       $96.00       $0.00
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1       $35.00      $16.70
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1      $385.00     $292.72
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1      $108.00       $0.00
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1      $397.00     $248.43
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1       $67.00       $0.00
    014267-05                104213378001 196487222  MICCO            GARY       01   22213923707          07/06/2023           1      $336.00      $33.05
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1       $40.00       $4.95
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1       $23.00       $0.00
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1       $40.00      $21.21
    014267-05                104213378001 196487222  MICCO            DINA       18   22214141511          07/20/2023           1      $167.00       $0.00
    014267-05                104213378001 196487222  MICCO            DOMENICO   19   22214096839          07/25/2023           1       $40.00       $2.99
    014267-05                104241138001 196668859  MCCRACKEN        BRENNA     19   22614259336          07/21/2023           1      $195.00       $0.00
    014267-05                104241138001 196668859  MCCRACKEN        BRENNA     19   22614259336          07/21/2023           1      $195.00       $0.00
    014267-05                104241138001 196668859  MCCRACKEN        BRENNA     19   22614259336          07/21/2023           1      $154.00       $0.00
    014267-05                104241138001 196668859  MCCRACKEN        CIARA      19   22614059114          07/24/2023           1      $140.00      $64.99
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032711459          07/20/2023           4       $28.00       $0.00
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032703617          07/20/2023           1      $135.00       $0.00
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032703617          07/20/2023           1      $141.00       $0.00
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032711459          07/20/2023           1       $51.00       $0.00
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032711459          07/20/2023           1      $187.00      $95.81
    014267-05                104318685001 197640477  HUDAK            DANIEL     19   22032900279          07/03/2023           1      $150.00      $60.70
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032703617          07/20/2023           1      $236.00       $0.00
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   22032703617          07/20/2023           1       $31.00       $0.00
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713964512          07/19/2023           1    $2,832.00     $211.50
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713959665          07/19/2023           1      $222.00      $77.70
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22714130893          07/19/2023           1       $34.00      $12.32
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713964512          07/19/2023           1    $1,990.00     $261.86
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22714130893          07/19/2023           1      $351.00     $116.05
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713964512          07/19/2023           1    $1,990.00     $253.24

                                                                                                                                              PAGE:48 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   22513944499          07/07/2023           1      $204.00      $57.79
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22513963018          07/07/2023           1      $209.00      $77.69
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023          48   $22,731.00   $5,837.20
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1    $5,600.00   $1,438.05
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023          18    $8,224.00   $2,111.88
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1    $1,027.00     $263.72
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           4    $6,291.00   $1,615.49
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           2      $122.50      $31.45
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           6    $3,168.00     $813.52
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023          19   $16,131.00   $4,142.36
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023          59   $23,098.50   $5,931.57
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1      $370.00      $95.01
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           2      $146.50      $37.62
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           2    $2,620.00     $673.02
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           2      $632.50     $162.42
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023         379    $8,145.25   $2,091.65
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1    $4,835.00   $1,241.60
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           3   $55,763.00  $14,319.65
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023          14    $7,028.00   $1,804.75
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1    $4,755.00   $1,221.06
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           2      $700.00     $179.75
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           5    $6,551.75   $1,682.45
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613041676          06/30/2023           1      $610.00     $156.64
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032387052          07/05/2023           1      $130.00     $110.01
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032814150          07/25/2023           1       $80.00       $8.32
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032814150          07/25/2023           2      $100.00      $49.16
    014267-05                116301876001 206603688  SHAFFER          ELIZABET   19   22814246539          07/26/2023           1    $1,855.16   $1,114.33
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22613866832          07/21/2023           1      $120.00     $110.01
    014267-05                105133917001 207507140  BORN             TIMOTHY    01   22714223761          07/03/2023           1      $130.00      $28.48
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   22313783473          05/24/2023          20       $15.44      $15.44
    014267-05                117760647001 208602985  ABEL             HANNAH     19   22314250182          07/19/2023           1      $193.00     $132.86
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   22314189589          07/25/2023           1      $239.00     $101.85

                                                                                                                                              PAGE:49 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313912771          07/19/2023           1      $688.00     $410.16
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           1       $40.00       $2.99
    014267-05                105242584001 208640494  WESTRICK         JORDAN     19   22414021556          07/24/2023           1       $40.00       $4.95
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           1      $185.00     $118.97
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           2       $80.00      $42.42
    014267-05                105242584001 208640494  WESTRICK         JORDAN     19   22414021556          07/24/2023           1       $40.00       $2.99
    014267-05                105242584001 208640494  WESTRICK         JORDAN     19   22414021556          07/24/2023           1      $185.00     $130.20
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           2       $80.00      $32.03
    014267-05                105242584001 208640494  WESTRICK         JORDAN     19   22414021556          07/24/2023           1       $35.00      $16.70
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           1       $85.00      $46.07
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           1      $220.00     $216.20
    014267-05                105242584001 208640494  WESTRICK         ALEXANDE   19   22414021555          07/24/2023           1       $35.00      $16.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1      $160.00      $61.45
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023         386      $386.00     $162.12
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022607          07/19/2023           1       $10.00       $7.88
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1       $11.00       $6.49
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1       $55.00      $40.16
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022607          07/19/2023           1       $89.00      $44.10
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1        $7.00       $5.57
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           2       $20.00      $17.94
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1      $256.00     $189.14
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1       $40.00      $28.02
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022607          07/19/2023           1       $45.00      $21.36
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          10      $450.00      $14.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1      $283.00     $119.87
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          19      $133.00     $105.83
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           2      $118.00      $83.12
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1      $275.00     $185.41
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          10      $100.00      $89.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          20        $2.00       $2.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          10       $10.00       $2.40
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023           1       $51.00      $16.99

                                                                                                                                              PAGE:50 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22114022608          07/19/2023          14       $14.00       $0.98
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313790851          07/19/2023           1       $84.00      $20.46
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313790851          07/19/2023           1        $7.00       $2.50
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313821360          06/29/2023           1      $150.00     $110.01
  014267-05 Total                                                                                                                  $206,723.62  $55,396.17
  014267-06
    014267-06                101267523001 160429168  PETRISKO         MICHAEL    01   22032880327          07/26/2023           1       $95.00      $65.70
    014267-06                112636195001 161586341  PARRISH          CHRISTIN   18   22714058150          07/25/2023           1       $80.00      $33.48
    014267-06                101824877001 167564735  LANZENDORFER     CLEMENT    01   22214165533          07/03/2023           1      $125.70     $100.81
    014267-06                101824877001 167564735  LANZENDORFER     CLEMENT    01   22214165533          07/03/2023           1       $13.99       $0.00
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           1      $158.00     $115.54
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           2      $201.00      $57.48
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           1      $105.00      $16.13
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           1       $29.00       $0.00
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           1      $153.00      $33.49
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   22413820166          07/08/2023           1      $126.00      $26.77
    014267-06                103272483001 185482246  DUMM             RALPH      18   22314000279          07/20/2023           1    $1,273.00     $503.60
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   22314098292          04/20/2023           1    $1,100.00     $538.02
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313966501          07/20/2023           1    $3,938.00     $624.82
    014267-06                103272483001 185482246  DUMM             RALPH      18   22314000279          07/20/2023           1      $917.00     $151.53
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313966501          07/20/2023           1    $4,326.00   $1,425.51
    014267-06                103272483001 185482246  DUMM             RALPH      18   22314180758          07/24/2023           1      $231.00      $84.19
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1       $80.00       $7.50
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1       $56.00       $3.50
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1       $72.00       $6.50
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1       $70.00       $5.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1       $82.00      $10.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22214238746          07/13/2023           1      $183.00     $100.81
    014267-06                126568873001 188582035  MYERS            KEVIN      01   22114113064          07/25/2023           1      $100.00      $52.85
    014267-06                104212846001 196485949  DAISLEY          TODD       18   22114173799          07/18/2023           1       $29.00      $19.51
    014267-06                112723490001 199583547  WEILAND          DANIEL     18   22213814547          07/18/2023           1       $59.00      $39.40
    014267-06                119289043001 201600245  NEUMANN          MARIE      19   22114024534          07/24/2023           1      $175.00     $116.03

                                                                                                                                              PAGE:51 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                119289043001 201600245  NEUMANN          MARIE      19   22114024534          07/24/2023           1       $13.70      $12.25
  014267-06 Total                                                                                                                   $13,791.39   $4,150.42
  014267-07
    014267-07                110529124001 124685815  RICUPERO         JULIANA    01   22713820306          07/17/2023           1      $163.00     $102.70
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032715526          07/19/2023           1      $848.00     $472.00
    014267-07                121106664001 159703665  KANE             SHANE      19   22032903818          07/26/2023           1      $195.00       $0.00
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032704005          07/19/2023           1      $500.00       $0.00
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032745510          07/23/2023           1      $347.00     $209.59
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032747484          07/19/2023           1       $97.00      $17.35
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032704005          07/19/2023           1    $5,706.00   $3,611.73
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032747484          07/19/2023           1      $687.00     $307.99
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032704005          07/19/2023           1      $250.00     $125.00
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/27/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/21/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          07/05/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/09/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/07/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/28/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513819492          07/13/2023          12      $284.40     $284.40
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   22513800413          07/18/2023           1      $118.00     $118.00
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   22514045214          07/18/2023           1      $148.10      $13.00
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513819492          07/10/2023          12      $188.76     $188.76
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   22513800413          07/18/2023           1       $20.00       $0.00
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513820616          06/20/2023           1      $100.00      $80.16
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513819492          07/12/2023          12      $188.76     $188.76
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513819492          07/13/2023          12      $188.76     $188.76
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513819492          07/11/2023          12      $188.76     $188.76
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   22514045214          07/18/2023           1       $88.07       $0.00
    014267-07                101529427001 163623940  WATT             MCKENZIE   19   22413798289          07/17/2023           1      $118.00     $118.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184179          07/05/2023           1      $150.00      $57.18
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184179          07/05/2023           1       $25.00       $5.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184137          06/14/2023           1      $125.00      $85.99

                                                                                                                                              PAGE:52 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184137          06/14/2023           1       $45.00      $33.32
    014267-07                101605583001 164627824  SALEME           HEIDI      18   22213921478          07/18/2023           1      $127.00     $126.32
    014267-07                101605583001 164627824  SALEME           HEIDI      18   22214026288          07/18/2023           1      $148.10      $13.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184138          06/19/2023           1       $20.00      $10.45
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184179          07/05/2023           1       $47.00      $10.50
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184138          06/19/2023           1       $20.00      $11.87
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184179          07/05/2023           1      $150.00      $70.70
    014267-07                101605583001 164627824  SALEME           HEIDI      18   22213921478          07/18/2023           1       $20.00       $5.91
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184137          06/14/2023           1       $20.00      $11.87
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184137          06/14/2023           1       $20.00      $10.45
    014267-07                101605583001 164627824  SALEME           MARAH      19   22214184138          06/19/2023           1       $45.00      $13.32
    014267-07                102080665001 170683038  MICHINA          DENNIS     01   22114266100          07/24/2023           1       $20.00       $5.91
    014267-07                102080665001 170683038  MICHINA          DENNIS     01   22114266100          07/24/2023           1      $127.00     $126.32
    014267-07                102160098001 171649555  BAKER            KIMBERLY   18   22032826515          07/20/2023           1      $349.00       $0.00
    014267-07                102160098001 171649555  BAKER            KIMBERLY   18   22032842180          07/18/2023           1      $260.00       $0.00
    014267-07                102160098001 171649555  BAKER            KIMBERLY   18   22032898761          07/20/2023           1       $90.00      $33.89
    014267-07                123674799001 172727548  BROWN            AMBER      18   22314008743          07/21/2023           1      $125.00      $65.70
    014267-07                123674799001 172727548  BROWN            JOHN       01   22313716950          07/06/2023           1      $150.00       $0.00
    014267-07                123674799001 172727548  BROWN            AMBER      18   22313833740          07/15/2023           1      $662.00       $0.00
    014267-07                102406412001 174667290  O'NEILL          CARRIE     18   22214183116          07/21/2023           1      $145.00      $59.97
    014267-07                102562858001 176587306  GIBBONS          CADEN      19   22113993016          06/27/2023           1      $150.00      $70.70
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   22113847512          07/17/2023           1      $691.00       $0.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313966139          07/20/2023           1      $236.00       $0.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313792524          07/20/2023           1      $160.00     $124.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313966139          07/20/2023           1      $217.00       $0.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313966139          07/20/2023           1       $31.00       $0.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313966139          07/20/2023           1      $190.00       $0.00
    014267-07                102807156001 179604238  RABATIN          MARISA     19   22313792524          07/20/2023           1       $25.00       $4.71
    014267-07                110660560001 179627622  WESSEL           LOUIS      01   22713820326          02/06/2023           1       $60.00       $8.73
    014267-07                110660560001 179627622  WESSEL           LOUIS      01   22706624341          02/06/2023          (1)    ($60.00)     ($8.73)
    014267-07                110660560001 179627622  WESSEL           LOUIS      01   22713820326          02/06/2023           1       $52.00      $10.78
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032520405          07/20/2023           1       $69.00      $22.60

                                                                                                                                              PAGE:53 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032520405          07/20/2023           3      $211.50      $73.74
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032520405          07/20/2023           1       $60.00      $12.84
    014267-07                122806756001 181726437  MARRA            BRITTANY   01   22113796904          07/18/2023           1      $250.00       $0.00
    014267-07                103024367001 182466226  WARNER           DAVID      01   22814094791          07/18/2023           1      $125.00      $65.70
    014267-07                103024367001 182466226  WARNER           DAVID      01   22814168985          07/18/2023           1      $275.00     $130.44
    014267-07                103058324001 182684804  LEE              KLOE       19   22813877066          07/19/2023           1      $223.00      $65.14
    014267-07                124239642001 182745822  LINK             MARIA      01   22613183876          07/05/2023           1      $703.00     $298.53
    014267-07                124239642001 182745822  LINK             MARIA      01   22613183876          07/05/2023           1      $675.00     $490.62
    014267-07                124239642001 182745822  LINK             MARIA      01   22613976261          07/05/2023           1      $110.00      $49.30
    014267-07                124239642001 182745822  LINK             MARIA      01   22613976261          07/05/2023           1      $146.00      $59.05
    014267-07                103271964001 185481106  ZELENSKI         JACOB      19   22713909204          07/14/2023           1      $230.00       $0.00
    014267-07                103879349001 192529999  WATT             LISA       01   22813857112          06/29/2023           1      $250.00      $13.21
    014267-07                103879349001 192529999  WATT             LISA       01   22813857112          06/29/2023           1    $3,500.00      $70.86
    014267-07                104394007001 198606951  MADISON          BRIAN      01   22113910847          07/13/2023           1      $104.00       $0.00
    014267-07                104394007001 198606951  MADISON          BRIAN      01   22113981846          07/20/2023           1       $31.00       $0.00
    014267-07                104394007001 198606951  MADISON          BRIAN      01   22113981846          07/20/2023           1      $360.00       $0.00
    014267-07                104804112001 203580135  SMITH            MICHELE    18   22314193096          07/27/2023           1       $95.00      $65.70
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           1      $193.60     $160.70
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           1        $7.00       $2.52
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           1      $436.00     $321.27
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           4      $162.80      $67.10
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           1      $144.00     $131.23
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           1      $198.00     $100.08
    014267-07                135952257001 204760740  MYERS            KALI       19   22314136330          07/24/2023           3      $178.20      $66.66
    014267-07                104976759001 205602810  CARRIZALES       MONICA     01   22314133811          07/26/2023           1       $39.00       $0.00
    014267-07                105150385001 207605575  KUNTZ            THERESA    18   22114017371          07/18/2023           1      $187.86      $78.26
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   22513870137          07/18/2023           1      $150.00     $110.01
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   22514202519          07/25/2023           1      $150.00     $110.01
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22113927532          07/11/2023           1      $951.00     $563.42
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22112822418          06/13/2023           1      $112.00      $72.85
    014267-07                121862944001 207724279  LEARY            VANESSA    19   22113927715          07/09/2023           1       $78.00       $0.00
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032633688          07/18/2023           1       $20.00       $0.00

                                                                                                                                              PAGE:54 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032764873          07/19/2023           1      $691.00       $0.00
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032993724          07/27/2023           1      $150.00      $35.46
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032633688          07/18/2023           1      $220.00      $94.89
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032993724          07/27/2023           1      $135.00      $53.94
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   22032527910          07/19/2023           1      $234.00       $0.00
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113796477          07/20/2023           3      $252.00      $73.74
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22114196846          07/25/2023           3      $252.00      $73.74
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22713953923          07/21/2023           1      $150.00     $110.01
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22714000403          07/20/2023           1       $10.00       $2.96
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22714000403          07/20/2023           1       $36.00      $17.49
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22714000403          07/20/2023           1      $231.00     $136.40
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22714000403          07/20/2023           1       $35.00       $3.13
  014267-07 Total                                                                                                                   $28,487.67  $11,467.38
  014267-08
    014267-08                114847328001 071624700  PRODORUTTI       THERESA    19   22214124989          07/20/2023           1       $49.00      $37.66
    014267-08                114847328001 071624700  PRODORUTTI       THERESA    19   22214124989          07/20/2023           1      $120.00      $83.67
    014267-08                101267755001 160429635  FLORA            MARK       18   22713818224          07/18/2023           1      $187.00     $100.81
    014267-08                127928506001 162602138  TREON            TINA       18   22413942935          07/13/2023           1      $512.00     $180.92
    014267-08                127928506001 162602138  TREON            TINA       18   22413942935          07/13/2023           1       $75.00      $48.06
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   22714315339          07/25/2023           1      $220.00      $89.89
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22713842953          07/10/2023           1      $126.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22214044462          07/24/2023           3        $6.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22214163242          07/18/2023           1       $47.00       $3.32
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22214044462          07/24/2023           1      $100.00      $65.70
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22214044462          07/24/2023           1       $35.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22214044462          07/24/2023           1        $2.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1       $67.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1       $96.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22814164760          07/24/2023           1      $209.00      $87.83
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1      $107.00       $0.00
    014267-08                102576284001 176682098  YARNISH          DOLLY      19   22814164758          07/24/2023           1      $260.00     $110.42
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1       $67.00       $0.00

                                                                                                                                              PAGE:55 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1       $23.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22814164761          07/24/2023           1       $15.00       $0.00
    014267-08                102576284001 176682098  YARNISH          DOLLY      19   22814164759          07/24/2023           1       $15.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1      $102.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813975881          07/20/2023           1       $67.00       $0.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813964848          07/17/2023           1       $75.00      $48.06
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813964848          07/17/2023           1      $512.00     $180.92
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22413937361          07/18/2023           1      $346.00     $129.19
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1       $96.00       $0.00
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1      $245.00       $0.00
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1      $108.00       $0.00
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1       $86.00       $0.00
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713853148          07/20/2023           1      $322.00     $127.86
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1       $23.00       $0.00
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22713975654          07/20/2023           1       $87.00       $0.00
    014267-08                104393562001 198605554  MCBREEN          AMBER      19   22614240853          07/05/2023           1      $150.00      $65.70
    014267-08                104393562001 198605554  MCBREEN          AMBER      19   22613869301          07/18/2023           1      $209.00      $90.81
    014267-08                110998339001 200645662  FEES             JENNY      18   22714276569          03/30/2023           1      $640.00     $430.70
    014267-08                105065403001 206621146  BAKER            LINDA      18   22614078572          07/11/2023           1      $185.00       $0.00
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   22414138265          07/25/2023           1      $175.00      $90.81
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   22414138265          07/25/2023           1       $50.00       $0.00
  014267-08 Total                                                                                                                    $5,816.00   $1,972.33
  014267-12
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   22313912814          07/11/2023           1      $436.00     $218.29
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   22313912814          07/11/2023           1       $53.00      $56.73
  014267-12 Total                                                                                                                      $489.00     $275.02
  014267-15
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213819418          07/20/2023           1       $50.00      $13.63
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213819418          07/20/2023           1       $80.00      $57.63
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213819418          07/20/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213819418          07/20/2023           1       $40.00       $0.00
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032706856          07/21/2023           1      $132.75      $69.89

                                                                                                                                              PAGE:56 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                102304935001 173545673  PARONISH         REBECCA    01   22032951233          07/25/2023           1      $110.00      $60.70
    014267-15                102304935001 173545673  PARONISH         REBECCA    01   22032951233          07/25/2023           1       $12.00       $2.50
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032706856          07/21/2023           1       $18.00      $13.48
    014267-15                102736003001 178626862  HOGAN            MARGUERI   19   22414106803          07/24/2023           1      $192.00     $110.50
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $125.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)    ($76.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $65.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $125.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)   ($132.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $14.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)   ($132.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $37.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)    ($14.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)    ($37.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $132.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $76.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023          (1)    ($65.00)       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $132.00       $0.00
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22214132966          07/19/2023           1    $3,600.00     $857.57
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22214135932          07/19/2023           1    $1,545.00     $241.46
    014267-15                103212512001 184605964  KIMMEL           RICHARD    18   22814277292          07/27/2023           1      $372.18      $77.69
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514148026          07/26/2023           1       $40.00      $10.45
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514148029          07/26/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514142441          07/24/2023           1       $50.00      $12.73
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514148029          07/26/2023           1       $50.00       $2.28
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514148029          07/26/2023           1       $45.00      $28.53
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514148029          07/26/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514142441          07/24/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514142441          07/24/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22514142441          07/24/2023           1       $45.00      $28.53
  014267-15 Total                                                                                                                    $7,071.93   $1,808.79
  014267-26

                                                                                                                                              PAGE:57 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22714130807          07/21/2023           1      $145.00      $54.97
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1       $31.00       $0.00
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1      $181.00      $70.64
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1      $569.00     $170.93
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1      $164.00      $72.40
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1      $217.00      $67.68
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313902004          07/19/2023           1      $561.00     $105.34
    014267-26                103619172001 189545507  DRISKEL          DONNA      01   22313780962          07/07/2023           1      $116.00       $0.00
    014267-26                103619172001 189545507  DRISKEL          DONNA      01   22313780962          07/07/2023           1      $105.00       $0.00
    014267-26                103945030001 193422246  BROWN            JOHN       18   22714174519          07/25/2023           1       $98.57      $74.18
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22032993951          07/12/2023           2       $94.00      $45.20
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22032993951          07/12/2023           1       $60.00      $40.00
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22514136703          07/21/2023           1       $70.50      $24.58
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22514136703          07/21/2023           1      $270.00      $83.63
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22514136703          07/21/2023           1       $69.00      $22.60
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22514136703          07/21/2023           1       $60.00      $12.84
  014267-26 Total                                                                                                                    $2,811.07     $844.99
  014267-36
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513955685          07/20/2023           1       $53.00      $11.04
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513955685          07/20/2023           1       $23.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513825360          07/12/2023           1       $33.00      $11.97
    014267-36                101597846001 164585882  BECQUET          DAWN       18   22514203003          07/03/2023           1      $150.00      $70.70
    014267-36                101597846001 164585882  BECQUET          DAWN       18   22514020694          06/28/2023           1      $150.00      $70.70
    014267-36                101742475001 166526179  CLAYCOMB         DAVID      18   22414192895          07/11/2023           1      $236.00       $0.00
    014267-36                101742475001 166526179  CLAYCOMB         DAVID      18   22413797968          07/18/2023           1      $145.00      $59.97
    014267-36                101742475001 166526179  CLAYCOMB         DAVID      18   22414192895          07/11/2023           1      $217.00       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22413937672          07/19/2023           1      $220.00      $89.89
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22414008236          07/19/2023           1       $31.00       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22414008236          07/19/2023           1      $141.00      $41.95
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22414008236          07/19/2023           1      $207.00      $74.38
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22413802000          07/19/2023           1      $151.50       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814174584          06/19/2023           1        $8.00       $3.25

                                                                                                                                              PAGE:58 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814174583          07/24/2023           1       $75.00      $43.87
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023       1,004       $62.84      $33.49
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          36       $41.67      $22.22
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($53.00)    ($12.91)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $23.00       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814271842          07/26/2023           1       $51.00      $36.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           2   $16,359.30       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1      $116.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)   ($168.00)    ($21.74)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           1       $93.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $247.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $93.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1      $168.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           2       $50.94       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023          13    $1,014.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           4    $9,937.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $67.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           9      $136.10       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)   ($116.00)    ($17.68)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           6       $66.15       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $93.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $22.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814157539          07/13/2023           1      $150.00      $12.36
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023         161      $107.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1      $226.00     $130.88
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          12      $132.30       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($30.00)     ($9.96)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           1       $93.00       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814174583          07/24/2023           1      $160.00     $105.81
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $30.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $354.00     $253.09
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814174585          07/12/2023           1        $8.00       $3.25

                                                                                                                                              PAGE:59 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           4       $22.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1   $15,209.00  $30,329.96
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           2       $22.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813599890          06/19/2023           1      $160.00      $87.69
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813854168          07/05/2023           1      $160.00     $105.81
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $53.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $53.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           4       $22.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          11    $2,068.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           2       $44.10       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           2      $246.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($23.00)       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($56.00)     ($7.99)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22811808345          06/19/2023          (1)     ($0.01)     ($0.01)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $67.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          12    $1,991.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $22.05      $11.74
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($67.00)    ($24.49)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           1      $161.00       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814174583          07/24/2023           1       $30.00      $20.20
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $23.15       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/14/2023           1       $22.05       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $247.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813599890          06/19/2023           1        $0.01       $0.01
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $56.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $193.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($67.00)    ($19.59)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          22    $3,642.35       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023          (1)    ($53.00)    ($10.82)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $354.00     $195.29
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023          15      $343.14       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1       $22.05       $0.00

                                                                                                                                              PAGE:60 of 60
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22814088926          07/13/2023           1      $193.00       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22814174583          07/24/2023           1       $20.00      $11.66
    014267-36                112032810001 208608905  WARGO            BRANDI     01   22032714593          06/27/2023           1      $290.00     $142.86
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213858041          07/13/2023           1      $339.00     $201.96
    014267-36                105326129001 209640969  WURM             ISAAC      19   22214124597          07/23/2023           1      $222.00      $56.49
    014267-36                135240920001 211701115  SNYDER           FRANCESC   18   22813820498          07/12/2023           1      $150.00      $55.46
    014267-36                135240920001 211701115  SNYDER           FRANCESC   18   22814203870          07/17/2023           1       $47.00      $13.32
  014267-36 Total                                                                                                                   $57,602.94  $32,182.08
  014267-37
    014267-37                134922147001 178526604  DILLON           LISA       18   22614271813          07/25/2023           1      $183.00      $74.99
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22714250450          07/25/2023           1       $56.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22714250450          07/25/2023           1       $80.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22714250450          07/25/2023           1       $56.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22714163858          07/24/2023           1      $322.00     $114.19
  014267-37 Total                                                                                                                      $697.00     $189.18
  014267- Total                                                                                                                    $388,227.82 $126,305.41
PPO Total                                                                                                                          $388,227.82 $126,305.41
Paid Claims Detail Total                                                                                                                       $250,058.90